July 27th, 2009

6 wks, 2 days-WBAT, swim, boot compare, fiberwire, risk of waiting for surgery, making progress

WBAT: I’ve now had the boot for 2 wks and am clear to do WBAT (weight bearing as tolerated) so I’m giving myself the green light to walk as much as possible and have even left the house with just one crutch (primarily for stairs and uneven pavement).  I’m still having trouble rocking my bad leg from heel to toe in a normal walk.  It puts a strain on the boot and I feel a stretching sensation mid-calf so my steps are short when planting the bad foot.

Comparing Boots: I’m noticing not all boots are created equally.  I was originally given an Aircast FP Walker boot but I also got an Ossur Equalizer Air Walker.  I like the plastic shell of the Aircast as it protects the leg from bumping into things but I think the Ossur is more comfortable and has a better rocking motion so I can get from heel to toe more easily.  I think I walk better in the Ossur.

Swim:  I swam over the weekend several times mostly to goof around with my kids but I did make a few laps.  I think the exercise was good.  There’s really no way to really tweak your achilles from what I could feel but the calf got a little exercise (for the first time it seems).  The only weird thing is that my AT felt very thick and hard afterward even when in the relaxed position.  This condition didn’t last long however.

Fiberwire:  I also ran into an old friend over the weekend who happens to now be an orthopedic surgeon who specializes in foot and ankle work.  He mentioned to me that at 6 wks he would have had me out of the boot already.  He uses a suture called Fiberwire, which he says is nearly impossible to break so he feel very comfortable moving people out of the boot quickly.  The products detractors say Fiberwire is hard and irritates surrounding tissue but he does an ATR surgery every week and says he’s had no problem with it.

Risks of Waiting for ATR Surgery:   My doctor friend also said that it’s really hard performing an ATR surgery when a patient doesn’t come in right after the injury.  Apparently, the loose tendon can scar/harden and contract and no amount of pulling (think of a doctor leaning back and yanking on it with all his might) can get that damn tendon back to where it needs to be.  I could be misquoting him on the details but I think he said they may have to flip a piece of muscle or tendon down from the calf and combine it with a tendon from your big toe to connect the two ends of the hardened and shorter tendon back together.  That sounds god awful.

My Progress:  I’m feeling better, more confident.  Every two days I feel like I’m gaining in flexibility and strength.  I am comfortably at 10 deg dorsiflexion and can do a few calf raises while seated (not sure how much I’m using my thigh to cheat but it’s progress).  I also stopped using a splint at night.  I simply wear an ace bandage.  My goal is to sneak off to the driving range next week to hit some balls if I’m feeling good.  I need to get out there.  Aside from the swimming, it’s been 6 weeks since any normal physical activities.

Good luck to everyone in their respective rehabs.

wubfree

July 22nd, 2009

5 wks, 4 days - PT, stiff but 10degs, taking it slow, pool, golf, Tom Watson

I’m 5 wks, 4 days - I’ve done 4 PT sessions and am still a little stiff but getting a little more ROM each couple of days.  I’m not at 10 degs past 90, with the PT pushing, I’m arguably an 11-12 degs past 90.

My incisions is healing up very nicely.  New skin is coming up from underneath and it looks pretty good.  After some weight bearing, I can get some minor swelling around the AT but nothing major.  The skin around my AT/heel is still somewhat tender to the touch tho.  It’s hard to explain but the the PT does soft tissue work around the area and the skin still feels somewhat sensitive like it’s slightly bruised and I can feel it on the outside of my AT/heel, the opposite side of the surgery - strange.  Hopefully this gets better as the days pass.

PT has been fine.  The dorsiflex stretch is probably the most uncomfortable thing.  I’m straining to reach 10 degs past 90 and I hear 15 is normal but I feel like I have a long way to being normal.  I think a big part of that is strength  - I’m still more focused on flexibility and doing very little active exercise of the calf muscle.  I am, however, doing some electrostim to get my calf activated - that still feels like a cramp.  It’s bearable but I clench my teeth when I feel it coming.

Against my doctor’s and PT’s orders, I try to bear weight around the house just to get used to putting pressure on my foot (in the boot).  I’m staying back on my heel so I’m not stretching the AT so I don’t think I’m risking injury.  I can walk but I haven’t tried long distances and in the back of my mind, I can hear my doctor saying “only PWB!”  I don’t feel like I could swing a golf club in the boot tho.  With all the weight transferring over to my left (bad) foot and the possibility of rocking up on the balls of my feet or doing any type of twisting with the boot on, I just don’t feel like I’m there yet.  (Tangent: It sure was nice albeit heartbreaking to watch Tom Watson competing in the British Open.  All that at 59 yrs old and with a fake hip no less!)  I’m approaching 6 wks tho and the doctor has cleared me to get into the pool so I can play with my kids.  That should be nice - it’s summer after all.

Hope everyone is progressing along with their respective protocols.  Regards,

July 16th, 2009

4wk, 5days- now PWB, small steps w/ no crutches

I had PT yesterday and did some weight bearing just to get the leg used to some pressure.  Today, I woke up feeling pretty good.  I was able to walk in my boot with a shortened stride - Bad leg forward, good leg forward but not much past bad leg.  There is very little discomfort.  Rocking forward on my bad leg will be the next step.  I  feel like there will be some stretch/strain if I move my knee forward past mid-foot as I step.

What also could be helping some is I’m wearing a cotton sleeve, like those used in casts, on my leg inside the boot.  This seems to lessen the irritation on the skin and scar that occurs as weight is applied and the leg shifts around and expands inside the boot.  I think a smooth sock would have the same impact.  I tried a sock but it just got way too hot.

July 15th, 2009

4 wk, 4 days PO - 1st PT session, past 90 degs!

Had first PT session 4 wks, 4 days post-op.  They started by asking a bunch of questions, doing a brief physical examination, and taking a bunch of measurements.

Then I did a few resistance exercises, followed by some massage/stretch.  The stretch was a little alarming but it’s like once you break the joint free, it’s like a new ROM limit is set.  So each stretch builds on previous stretches.  I’m supposedly 5 degs past 90, so I’m pleased.  I’m also able to put my heel all the way down in my boot.  The massaging felt very productive.  It felt like it moved the skin and tissue around to loosen everything up.  I still have a little soreness above my incision site, doctor thought it was the tendon, PT think it’s where the muscle and tendon meet.  Finally, I did some electrostim while icing.

I feel like every 6 hours, my ankle gets more flexible but it’s still very weak.  The PT is taking me slow and wants me to do some resistance exercises between sessions.  I personally think I just need to keep putting a little more weight on my leg to gain confidence to stand and eventually walk.  I can sort of stand there w/ partial weight.

July 14th, 2009

4wks, 3 days post-op: AT tighter than a……..

A day after my 4 wk post-op ortho visit - I’m trying to increase ROM and do mild resistance training.  MAN, IS MY AT TIGHT!  It doesn’t feel like muscle tightness.  It simply feels like it’s physically impossible to move it past that certain point.  At that point, it’s not what I would call pain, it’s more like discomfort and that sense that if you were to move past that certain point, there would most certainly be pain.  When I stand, I can feel stretching in what I believe to be the tendon and the skin which hasn’t moved much in the past 4 wks.  In the last 24 hours tho, I’ve already made strides however.  I’m close to 90 already and hoping to be comfortably past 90 by the end of the week.   If I can get there, I should be able to stand.  Walking hopefully follows soon after.

July 13th, 2009

Wk 4 ortho visit - in the boot!

Both my doctor and I came away very encouraged by my wk 4 progress.  The wound looked good and I was able to push w/ my foot downward against the doctors hand.  There was mild swelling in the tendon, which I’m glad the doc noticed.   He gave me a boot (Aircast) as well as a splint for nighttime and told me to schedule PT.  Recall, he started out by saying 4 wks in a splint, then said 6 wks, so I am actually pleasantly surprised that he wants me to start the active rehab process now.  The PT is 2x/wk and is to include progressive weight bearing (starting at 20lbs and increasing by 20lbs per week).

SCAR WK 4

He estimates that I’ll be 90 degs by the end of the week, FWB after 4 wks, AND in this boot for a total of 6 wks.  He also said that if I have the boot on, it will be very difficult for me to rerupture or otherwise injure myself.  He said that the tendon is not really what stretches from this point on, it’s really the tissue around the AT and the calf muscle, which makes sense to me.

I’m feeling good about the greenlight to start moving and rehabbing.  This is mentally a big transition point in the recovery process for me because I’m going from laying around all day to doing something - stretching, pushing, eventually standing, etc.  I’m hoping to get FWB ASAP.  I want to walk, hit golf balls, etc again before the summer is over.

The boot is not that heavy but it gets hot (and sweaty) in there which I generally dislike.

THE BOOT

LONG WAY TO GO BUT IT’S TIME TO GO TO WORK!!

Good luck to you all.

July 12th, 2009

slight impatience at the end of wk 4

Starting to feel the urge to keep pace w/ some of the other wk4 and 5 post-opers

I want to listen to my doctor.  I really do.  BUT having completed wk 4 myself and seeing several people on the blog at wk 4 and 5 starting to bear weight and walk, I’m starting to get the urge to move from splint to boot (NOW) and start trying to stretch, stand, and eventually walk.  I’m feeling pretty good inside the splint, I’m flexing and moving the foot without any pain and think I probably could start doing more, especially as I see many on the blog starting to do so.  I have to balance that with the fact that these are just weeks in the grand scheme of what hopefully is many years of activity with a healthy AT.  We’ll see what the doc says tomorrow.

July 11th, 2009

Checking out the damage end of wk 4

My 4 wk post-op is this coming Monday so I took the opportunity to remove my splint, clean up my leg, and check out the damage (scar, ROM, etc)

First, I removed all the tape strips.  The wound looked ok - not too raised (keloid) or gnarly from staples (a la Frankenscar).  There is some black stuff along the incision but I don’t think it’s a scab.   I think it’s black marker the doctor used to plan his incision, which should come off after a few washes.  I feel very encouraged by how the wound is healing up.  I felt around on the tendon as well.  It wasn’t swelling but it felt a little hard and thick all along the tendon above the incision.

To prevent injury, I sat on a stool next to my bathtub and hung my left leg into the tub under running water.  I used liquid soap and warm water.  Thus far, I’ve used wetwipes to clean my foot and leg but have yet to go near area of the incision.  So for the wound, this is the first wash in 4 wks.  It didn’t reek at all thankfully but there was a lot of excess skin flaking off.  It felt very refreshing to clean the whole leg up.

I took the opportunity to move the ankle joint to see where my ROM was.  I didn’t have much.  I could passively move it with my hand to LESS than half way between equinus and 90 (or zero) before I felt tension on my AT.  My doctor is taking me along slowly so I stopped right there.  I did not want to feel a stretch.  After checking out the injury and ROM, I’m realizing that there is not much strength or stability in the ankle, which makes me feel like  I have some work to do to get to 90 degs and have a long way to go before I’ll be able to run and hop. One step at a time tho.

My splint is made of 3-5 layers of fiberglass with many layers of cotton padding.  I arrange the cotton padding with a little extra padding around heel to prevent excess pressure on the back of my heel.  I’ve mentioned this several times but it’s so important for comfort.  I also wrap the ace over the splint with more tension at the balls of the feet and at the top of my calf just below the knee.  Too much tension around the ankle area seems to result in that annoying and sometimes painful pressure on my heel.

With the splint on, I’m starting to do some minor movements, repeatedly raising my foot slightly, as well as repeatedly flexing my calf muscle not for movement but to get some activity for the muscle.  I’m taking a cue from Doug53 to prevent atrophy so that I’ll have a little bit of muscle to begin PT in a 2 wks if that’s what my doctor wants (recall that my doctor started by saying I’d be splinted for 4 wks then changed his stance to 6 wks for no specific reason.)

More Monday after I see the ortho.

July 6th, 2009

List of professional athletes w/ ATR - just a start

This whole exercise may have been done before but pls feel free to add…

Dominique Wilkins - Atlanta Hawks

Lawrence Taylor - New York Giants

Dan Marino - Miami Dolphins

Vinny Testaverde - New York Jets

Lavarr Arrington - New York Giants

Greg Ellis - Dallas Cowboys

Kevin Smith - Dallas Cowboys

Elton Brand - Los Angeles Clippers

Christian Laettner - Atlanta Hawks

Misty May Treanor - Olympic Gold Medalist in Volleyball

Donovan Bailey - Olympic Gold Medalist in 100m

Dame Kelly Holmes double Olympic Champion 800 and l500 metres 2004

Curtis Davies Footballer Aston Villa

Valeri Bojinov Footballer Manchester City Football Club

Yakubu Footballer Everton Football Club

Mike Brown, Safety, Chicago Bears

Honorable Mention:  Edge, Pro Wrestler

July 5th, 2009

Mild Tendon Soreness Above Rupture - wk 3

It’s not pain but I have a very mild soreness (to the touch only) higher up on my AT above where the rupture was repaired and just below the ball of the calf muscle.  It feels like a sore muscle but it’s on the tendon.  I asked my doctor about it, he said it was normal but I didn’t push for an explanation.  I am wondering what is causing it since it’s on the tendon but nowhere near the area of rupture.

All else going as planned, laying back, doing some upper body exercises - 3 wks down and 3 to go in the splint NWB, based on my protocol.  I hope everyone else is setback-free.

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