Long overdue…

August 21, 2013 | | 5 Comments

So it’s been a long time since I’ve posted anything to this blog. I’m at about 6 months post injury/surgery now. My goal was to be almost 100% by this point but alas this injury is not so easy to recover from! I’m able to do everything a normal person would want to do…walk, play with the kid, bike, etc. One thing I did early on during recovery that I regret is going a little too hard on activities. I did a couple of 5+hr hikes in Eastern Oregon in June and started biking 25+mi a day, a lot of it on hills.

This was before I could do a heel lift.

I had to compensate for lack of calf muscle actuation by using other muscles and as a result ended up with Posterior Tibial Tendinitis. Fairly common among runners, Rx tends to be rest, orthotics to support the flat foot that I have to prevent further injury, and in the worst case, a walking boot. I’ve been dealing with this for the last few months and it seems to never get better. It’s much better than when it was diagnosed, but I still feel pain in the PTT when I point my toes or put weight towards the inside of the foot.

The bummer is that it’s preventing me from fully rehabbing my achilles and calf…I can now do a single heel lift but not full extension since my PTT acts up. It’s been tough to see the summer waste away.

So, the lesson here is to take it easy during recovery! Or, at least if you are going to go hard, do it the smart way.

So here I am a bit past 12 weeks since surgery. I continue to do many of the exercises I learned at PT, focusing on balance and strength. I learned that trying the wiggle board and other balance “toys” at PT that I really don’t have good balance…not just on my injured leg but on my good side as well! I’m trying to focus on doing my balance exercises for both legs now. Maybe it will help me reduce chance for injuries in the future? I hope so!

I wrote in my last post that I was getting myself ready to ride outside, and have done so successfully on three occasions. The first bike ride was a functional one: to my weekly PT appointment. I left the clipless pedals off and rode on the platform. It was so nice moving on a bike again OUTSIDE as opposed to being strapped to the trainer. This was right around 11 weeks and my strength was not as good as it is now, so making stops at intersections and getting going again was a bit tricky. This past Sunday (so right at 12 weeks) I went on a more adventurous ride over the hills in Portland to the zoo. From my house the total ride was only about 9 miles but involved about 900ft of climbing through the ride. Definitely noticed the low power output from my right leg so I had to compensate with my left, but I made it up and over and back again without issues. I also wished my bike had a front derailleur so I could shift down a bit (my bike is setup 1×10 which was perfect before), but I gutted through the ride especially when the grades topped 10%. The next day I noticed how much looser my tendon was, which speaks to the importance of “pushing” it a bit at least for me and my recovery!

Over the last week I’ve also been doing a lot of walking with my 10mo old daughter strapped to the front of me (weight training?). We go for ~2mi walks as time permits, and multiple times on the weekends. Again, concentrating on push off and normal gait has been very helpful.

Going to try posting when something “new” happens…I’m sure they are going to come at a slower pace now but I’m happy with progress so far and know that I’ll keep on getting better.

Hello! I’m continuing to improve…almost no limp when walking, walking downstairs like a champ (reference Norm’s method), and doing a lot of strengthening exercises and flexibility exercises on the bad leg. Starting to do calf raises on the weight machines at PT and doing single leg squats to increase flexibility and strength. Also simulates waking on stairs “normally” by getting a bit of DF by lots of knee bending.

Also working on the bike at home. Regularly panting and working up a huge sweat and now using my clipless pedals on both feet. Trying to simulate clipping in and out at virtual “stops” to practice for when I’m ready to venture outside. Just as an aside I converted my Cyclocross bike into a flat bar bike using some flat CF bar from Easton and Shimano trigger shifters that are compatible with road components. I never got along with drops although I’ve owned road bikes for over 10 years…always felt more comfortable on my mountain bikes. Figured it will help my transition to the road anyway.

Finally getting moving on my feet a lot these days to strengthen the legs. Went on a short hike yesterday on trails for about an hour (3mi). Uphill and downhill was great and I had my wife for support just in case (great supportive beautiful wife and we were celebrating our fifth year anniversary yesterday).

The key here though is extra precaution and keeping myself mindful of being careful. I still use a chair in the bathroom to change. Keeping stools and chairs around the house for balance. Railings on stairways. Reading about re rupture at week 11 makes it too real of a possibility and keeps me focused. I like getting better and am pushing myself in PT and exercising at home but I’d hate to be back to where I was 3 months ago! It’s strange how normal I am now but somehow NOT normal… To everyone out there, keep on healing, and have a safe and enjoyable Mother’s Day tomorrow! Call your mom!!

9 weeks post OP

April 26, 2013 | | 7 Comments

I’ve continued to go to PT twice a week and the amount of work we have done have increased each time. The “worst” part is the ASTIM (the “massage” using a plastic torture device) intensity seems to increase daily and I’ve started to make whimpering noises during the treatment…! It’s all good, I tell myself, but I have to ice myself in the entire leg since PT has started to do this for my entire leg…how fun!

Aside from that, lots of balance exercises using balance boards and what not…doing criss cross side movements up and down the gym, “marching” type steps to force balance on each leg while moving, and one leg balance on the floor and foam for 30sec-1min at a time. The work at home has been similar, boot has been ditched inside as of a week or so ago and focusing on smooth stride (heel strike, push off with ball of foot). Lots of stretching of the calf now with knee bent and straight to work both calf muscles (hold 30sec at a time). This has really improved my DF ROM.

Another item I’ve added is biking without the boot. That gets my blood flowing and lets me do the stretching more effectively. I’ve had to back off a bit on intensity from when I had the boot on for biking but the effect has been tremendous. Of course, pedal is positioned near the center of the foot rather than at the ball to reduce tendon load. I’ll increase intensity incrementally so I can be dripping in sweat again…

I also had my third Ortho check up today. He was very happy with the progress I’ve made. I was semi-nervous going in because I had accelerated his protocol, but since he had talked with my PT (they are next door) from time to time and understood I was working out of the boot he didn’t even mention not following his protocol. Of course, he did mention most of his patients are in the boot for 12 weeks and are now beginning to be FWB once or twice during the visit… Anyway, I’m now cleared to wean the boot outside as well, given clearance to drive (I drive cars with three pedals [manual]), bike outside if I have the boot on, etc. Lots of emphasis on remembering that even as strength comes back in the next few weeks/months my tendon is still a weak link and that I need to take it easy. No sprinting! No tennis! Etc.

I’ll do a quick post about what my PT has had me doing during the sessions and at home. I started at couple of days after Wk6…so let’s just call it Wk6.

Wk6 1st Session

Basically just to evaluate how I’m doing so far…how did I injure myself, what’s my ROM, etc. I was not even close to Neutral despite my boot being neutral (she measured at ~10degPF). I got some massage and a bit of stretch in my foot/achilles which felt good. Nothing disturbingly difficult or scary. I was told to start active ROM in all directions, and to do it 5sec at a time working the muscles. Doing this in DF has helped my ROM.

Wk6 2nd session

So this session was a bit more fun. More massage and stretching. ROM has improved but she didn’t measure it this time. Did some BAPS for ROM and balance, introduction of Thera Band (green) for strengthening in PF direction only, and had me stand on bare feet without boot which felt very strange. I was to add the thera band and standing exercises at home, which has been great for balance and strength in the calf. PT encouraged me to shorten the band as much as I want to increase resistance if I felt up to it, so I’ve been doing that. Weight shift exercise on bare feet feel great too as I feel like I’m getting stronger.

Wk7 Session 1

This was today…PT had me doing a lot more today. She introduced the plastic torture device to work on my scar and tendon. No more nice massages. That definitely hurt; I’m going to have to ice tonight! Also, I took my first steps outside the boot in ages today. Not very long, maybe 10-20ft at a time but with no aides which felt scary but confidence inspiring at the same time (when I completed the first few steps, of course). It was probably less than 50yrds all together but hey, that’s 50yds longer than I’ve walked in 8 weeks! Although improving, the ROM in DF direction is still around neutral, and my Ortho apparently still does NOT want me past neutral so walking was a difficult affair. It’s a limp, not a walk. Also stood on a balance board with both feet…and then did some one foot balance exercise on a piece of foam. I’m to add walking exercises around the house in controlled environments to the exercises I’m doing each day. Those few steps were exciting! They will get better as I’m allowed to do some stretching to improve DF past neutral; you just can’t walk without DF.

All in all, good PT session. I’ll keep updating with PT progress and whatever news I get out of the Ortho next week…

Just a quick update on my status. I’ve reduced the angle on my boot from 5deg PF to Neutral as of last night. It was a bit tight as expected this morning at the tendon and calf but it’s starting to feel better as the day goes on…

As of a couple of days ago I am FWB. I increased the weight on the injured leg through the last week or so and one day found that I could “balance” on it for a second or so at a time if I leveled up. I’m still working on my gait, but it’s nice to be crutch free. I still take the crutches with me outside just in case, and I have them by the bed in the morning because it takes me a few moments to let my foot learn how to bear weight (it has short term memory I guess).

Even though I’m at neutral, I’m still using the “Wedge” rocker sole on the Vacocast. The flatter sole, which OPED still calls a “Rocker Sole”, is a bit too flat feeling and I cannot roll on it comfortably. It also feels like OPED’s definition of neutral is not really neutral. I put the flat sole on and even up the other leg and I can see that the foot/leg are not at 90deg. Anyway, I think I will work on the gait with the easier wedge rocker sole for the next few days and then move on to the flat sole so that I can be balanced better with the other side. I’m using old Teva’s inside the house with modified height. For outside I’m using a few foam inserts along with a 3/4 gel insole to raise it up in a leather boot. It’s not quite level but almost there. Again, moving from the wedge sole to flat rocker sole will help.

I have a PT appointment coming up on Monday…it’s supposed to be an evaluation only, but I’m glad to get started. Since I’m deviating slightly from the Doc’s orders, I will make sure I crutch in to the office. (The doc said to start weight bearing at Wk6, though, so I am not too far off from his protocol.)

Also, another flight coming up for me on Tuesday. This time it’s a business trip so I won’t have my wife’s assistance. I’m bringing the crutches for the sympathy vote at the airport security lines but was also considering the knee scooter to get around the airport. Walking lengths at airports can be very LONG so it might help to have the scooter… The sad part about it is that it’s a conference at Deer Valley and I was hoping to get some spring skiing in before I had this injury. Oh well!

5 weeks post OP

March 29, 2013 | | 8 Comments

Hello AchillesBlog folks!  I wanted  to update my status from a couple of weeks ago. Really not much has happened on my achilles recovery due to the limited activity my doc is allowing, although it does feel much stronger when out of the boot than 3 weeks ago when I came out of the splint into the boot. I’ve gotten used to sleeping with the boot on and generally enjoy wearing it. I got an additional liner from Vaco’s website (their new “cool” liner) just before I left for my trip to Hawaii…both to allow me to wash one liner while being protected with the other.

Hawaii was more fun than I imagined with a bum leg. My doc did OK me to go in the pool and I did so with the Vacocast. Very strange feeling, with the boot floating up in the water. I mainly stayed in the shallow kiddie pool area with my boot above the water line, though, as I played with my 8-month old. She did great in the pool…not as happy in the ocean. Maybe next year. It was a bummer for me that I did not get to go into the ocean or to even get close enough to see my kid’s expressions as she was experiencing the sea for the first time. But all in all, it was great to warm up, soak in the sun, and lay in shallow pool water. Much recommended for sanity’s sake.

I did unfortunately have a few scares there. I brought crutches and the knee scooter with me (scooter was gate checked at the plane so it was waiting for me as I deplaned…pretty much essential to get around the airport!). The first night I went out to get dinner for the fam while wife got the fussy baby ready for the night, and in the dark I did a semi-endo over the bars when I was crossing some railroad tracks. Luckily no pain as I had my left foot down, hands on handlebards, but I landed with my bad leg also. The next day I was doing some laundry on crutches and slipped as I had too many things in my hands. I had to step forward and instinctively put my bad foot down. This time, I felt it in my foot and achilles, which freaked me out. i took the boot off to investigate and elevated the ankle; pain subsided for only a minute and there was not much swelling but I was extra careful after this. In fact I had begun some very light PWB before the trip but I stopped all of that and relied on my knee scooter exclusively and did not touch my crutches for several days. Staying in a condo with elevators helped (I live in a townhouse at home with lots of stairs so I’m bound to the crutches). Pain I was having in my upper back dissapeared also at this time so I felt good about it.

Coming home I decided that I should call the doc and let him know what happened. He decided he wanted to have me come in so he can examine me. He felt around the tendon and said there are no gaps, had me push down on his hand (plantar flex) and said I had good strength. Thompson test was positive, though, but he thought that was likely due to my ankle’s resting point. He assessed that I was still OK and told me he had me come in because a patient of his had recently re-ruptured. The guy was out walking his dog in shoes, no crutches, and fell. Apparently he was still supposed to be in a boot (didnt ask how many weeks post-op he was). Of course, with my doc being so conservative the guy could have been at the 8 or 10 week mark…

Anyway, for the rest of my recovery it looks like he still wanted me to move to 0deg at 6 weeks Post OP and then to begin PWB, increasing weight each week until FWB. I decided to begin PWB now to help me with stability since I’m back on crutches; a controlled planting of the boot seems safer than an accidental step. I will work up to 0 degrees more or less around 6 weeks (maybe a few days after, since I have the option to change in 5 deg increments; I’m at 10 deg right now). My ROM is fairly limited but improving somewhat. He’s also having me massage myself on the scar gently to help with adhesions. PT will start at week 7 or so, although I booked it at just a few days after week 6 to get me started.

All in all, things are looking up…it’s been a roller coaster ride the last few weeks, but I imagine this is the way it’s going to be until I’m COMPLETELY healed which seems like a long ways off yet.

One question before I go: people seem to get creative in raising the other foot to even out the height with the boot for walking. There’s OPED’s “Even-up” but what else have others done? Specifically looking for brands/shoes that are dressy (men’s) but has some meaty soles. I can think of old Doc Mertens or something I could look for at the local Goodwill but anything else work for you guys?

Post Op Day 18

March 12, 2013 |  Tagged , , , | 9 Comments

I had my post op check up on the 7th. Before then I had been put in a splint (front open) which allowed me to ice from the top which helped surprisingly well. Lots of elevating and icing…I hardly got up and was diligently following doctors orders. I stopped taking a lot of Tylenol near the end of my first 2 weeks so I could have a beer every once in a while. I found that drinking did make me swell a bit so I limited it to one beer every few days…but that first sip of the Lagunitas IPA  was heavenly!

I spent  a lot of time working from the bed and also checking out the blogs for info on what I should expect for recovery. I couldn’t remember what my doc’s protocol was but I knew I’d be in a “Duplex” boot. Come to find out that it is actually a Vacocast but the medical group the ortho clinic uses takes the logo off the Vacocast and puts their own logo on it. I’m pretty sure that is done so they can bill at a higher rate to insurance. Anyway, reading the blog posts had me hopeful for a semi-aggressive protocol of some weight bearing being allowed on the bad leg. If for anything to strengthen it a bit as I’d been off it so long already (3 weeks including the 1 week prior to surgery).

So back to my first post op check (at 2 weeks Post Op). It was very standard…go in, get the splint off, look at incision. Doc comes in and takes my sutures out. It was slightly painful, but more of a prickly feeling. Not pleasant, though. The wound looks pretty good…I’ll attempt to post pictures below (I actually have pictures and a video from during the operation also taken on my iPhone. I don’t want to gross anyone out but it’s pretty cool.) After taking the sutures out Doc tells me NWB for another 4 weeks. 20deg PF for 2 weeks, then 10deg, and then neutral by the time I see him again in 4 weeks, all controlled by the Vacocast they are fitting me in. I got clearance to travel to Hawaii (leaving in a week!); I forgot to talk specifics about activities I can do but Pre-Op he said I could swim in the pool so I may attempt that. Anyway, I was half expecting a bit more aggressive protocol given the postings on this blog but it seems this doc is in the “6 weeks NWB” camp. No instructions for ROM exercises either.

So, what have I been doing the past 4 days? I’m not really “PWB’ing” but am resting my leg when I stand now (using crutches), about the same pressure as if I were to rest my leg when I’m sitting in a chair (which by the way I didn’t do at all during the first 2 weeks…I was really NWB, not even the weight of my leg while sitting). The boot feels very secure. I did feel some tenderness in my tendon area after I went into the boot. I think it was the combination of having some freedom from a support during showers and being put in a 20deg angle rather than the approx 30deg I was at post op. The tenderness is now gone (took a day or so), but I feel more discomfort from the boot than I did the splint. The extra weight doesn’t help, certainly.

I also am doing very light ROM “exercises” when I’m in the shower. I have very limited range of motion, but I see bits of improvement even in the last 3 or 4 days. Foot still “twitches” when I move it but it’s getting better side to side.

Finally I’m trying to get outside more. On Saturday some friends stopped by so we took a bit of a walk in the neighborhood to a cafe and back…about 0.8mi total on the crutches. It was great exercise, and I was sore the next day. Took another walk yesterday (Monday)for about 0.6mi which was not as tiring as the previous walk. Wife wants me to get a knee scooter so I can be more mobile (she saw someone with an ankle injury on one cruising around TJ’s). I’m secretly wanting to progress more to a FWB state soon but also know I should try and listen to doctors orders. I suppose I can always sell the knee scooter afterwards (rental is expensive and my insurance will not cover it). What’s the general consensus on knee scooters in this blog community?

So day of surgery rolls around on 2/22. The move for the Operation from the Outpatient facility to the hospital is actually a positive for me since I live literally two blocks away. My wife drove me since she is so nice but drove back to park at the house and walked to the lobby. Standard issue stuff at the hospital as I was being prepped. They had me flip over to put the nerve block but I don’t remember a thing after flipping over until I woke up several hours later in recovery. That was one of the deepest “sleep” I’ve had ever. I felt great.

Further on in recovery I felt some pain and uneasiness in my leg. The nerve block only worked on one side of my leg, strangely enough. Anesthesia came up and talked to me and they agreed to redo the block for me so I’d have a longer period of comfort. This time they went up higher in the leg in m thigh, which meant that my entire right leg would be useless for about 24hrs. Even after that it was strange how some parts, especially the back of my leg, was not numb. But it felt better and I was on my way home… They wheeled me to the lobby, and we asked if we could take the wheelchair all the way home since we’re only 2 blocks away. The nurse nervously said yes so we braved the rain and my wife rolled me home. It would have been a chore for her to lift my numb leg into the car so this was nice.

Back home it was just sit on the bed and rest. We took home one of the urinal bottles so I could use it if I didn’t feel up to standing to go to the bathroom. I made use of it in the middle of the night. Day 2 was when the pain started. It’s kind of a scary thing and  I wasn’t doing a good enough job of “staying ahead of the pain”. I had to get Oxycodone by calling in the on-call doc as what they had given me wasn’t working. This eased the pain somewhat and I was able to sleep. This lasted until the end of Day 3 or so when I started to wean off the meds…by Day 4 I was using Tylenol only. This entire time was spent on the bed with leg elevated and icing almost constantly over the top of the splint (only ace bandages on the top). I also iced behind the knee based on advice from Nurse. My wife was a champ during this time, with helping me get up when I needed to, getting me ice, food, and even dumping the urinal…

I was not really ready for the next set of pain to reach me. Constipation. Narcotics used as pain killers slow everything down, and that includes bowel movement. I’d never experienced anything like it before in my life and was in extreme pain. This was even with the stool softeners I was taking from Day 2 or so (ignored wife’s warnings on Day 1, I shouldn’t have). After an all day agonizing ordeal it was through but then I dealt with diarrhea (probably the softener taking effect). Maybe this is TMI for some but just be warned when taking those pain meds to stay on top of whatever counter measures you have for bowel movement!


March 6, 2013 | | 2 Comments

I had some second doubts about the route I was going. I injured myself on 2/16, went to the ER on 2/17 and was all set to try and acquire an appointment for 2/19 to be seen as quickly as possible for my Achilles Tendon Rupture (ATR). This, as I learned through various ATR blogs of other people going through the exact same issues, is because scar tissue can start to form around the tendon and it was generally advised to have surgery within a week to 10 days of rupture. I knew how surgeons can be booked for weeks or months in advance so that’s why I went the ER –> Referral route in the first place.

I decided to call the Ortho Practice on 2/18 and leave a message so that I can be scheduled first thing on 2/19. It turns out that this office checks their messages during holidays…I get a call back right away explaining that they will do their best to get me in as soon as possible the next day. Unfortunately, I learn that the physician I was referred to had a full plate and decided to give this case to a younger partner at the practice. Thinking back now it makes sense that this happened…Achilles Tendon surgery probably pays a lot less than joint replacement work could. In any case I was a bit concerned as I wanted the best care possible, but decided time was of the essence and without any luck at several Portland area ortho/sports medicine clinics I decided to go with the referral.

The surgeon was younger and had been in the practice for a little over a year, having practiced at another facility previously. We went over the Thomson test again and he also validated the past diagnosis. Surprisingly he didn’t insist on an MRI to verify; he said he could order that if we wanted, but it wouldn’t change the way he would operate. He also gave me the option of Operate or Not Operating…if we wanted to go the non-operative route he would refer me to another doctor in their practice. He was very open and discussed the options with us in detail. I felt comfortable about it so I gave him the go ahead to schedule the Surgery.

The next day I get a call and hear that our insurance would not clear the use of their facility for some reason so I was to go to the local hospital instead. No problem for me, as the hospital was only 2 blocks away from my house! So, surgery was set for 2/22 and I started the waiting game…the nerves were getting to me and I felt optimistic about people who said they felt very little pain afterwards, but also realistic that the likely scenario was a world of hurt once the nerve blocks wore off.