40 Weeks. Been awhile!

February 5, 2010 | | 2 Comments

Hi. So I’ve very obviously neglected this site as my progress increased to a point where I was basically 100% functional again. Let’s to a little recap. It’s been about 6 months since my last post. And I’m about 3 months shy of my 1 year anniversary of my rupture. What’s happened since?

Well, I worked pretty extensively with the more sports-oriented trainer I mentioned, and saw my surgeon who cleared me and told me I was good to go and I could continue to see my PT or not. It was my choice. That was probably at around the 15 week mark.

I encountered a bit of an insurance f-up and I wasn’t able to continue PT anyway, so I had to stop regardless of whether I wanted to. In the intervening months, my gait has gotten stronger, and I have now fully transitioned back into normal shoes (even stiff dress shoes) and my scar is healing nicely. it’s still quite purple in parts, but I’m told it takes a long time for these things to fade, and to be frank, I’m not as nice to it as I should be.

When it comes to flexibility, my ruptured tendon is actually more pliable in some ways than my uninjured one, however given the way my ATR was repaired, there is an issue with the very top range of my plantarflexion. Whilst standing on the toes of my injured foot, I can’t really extent my foot all the way to the top of my range. When I don’t have any weight on it, there’s no problem. I think it’s a combination of strength and the way my repair was done that’s making this happen.

I still need to build my left calf up a bit. I have very bulky, compact calf muscles (which my surgeon told me is part fo what contributed to this injury) and my right calf is still more developed than my left. I am working with a personal trainer to both drop some of the weight I gained while I was injured and haven’t really been able to lose, as well as isolate my left calf and try to regain as much of the strength as I can.

I still haven’t been back on the court yet, but I think I’ll be ready for that in about a month or so when I drop some poundage and reduce the load on my lower body.

What’s funny is looking back on the whole ordeal, now that I’m basically out of it, I hardly even remember it all. I know I had one miserable summer on crutches, but luckily enough I was so busy with work (I work on political campaigns) that I associate that time more with the stress of the campaign than with the stress of being injured. I vividly remember hurting myself, and the ensuing ordeal of finding a surgeon and dealing with the hospital and all that, but the short term recovery, the first 10 weeks or so, is completely a blur.

If there’s one thing I can recommend, it’s just keep yourself busy. The time will go faster and you won’t be able to dwell on your injury nearly as much. That, and get a good PT who understands your goals and everything you want to be able to do once you’re back on your feet.

Also, if you’re in NYC and you mess up your achilles, go see Dr. Joseph Fetto at NYU. He is the greatest orthopedic surgeon EVER.

Hi all. So it’s been awhile since my last update. Here’s where I am at 14 weeks. I’m currently walking in two shoes with no problem, but my scar prevents me from wearing anything but runners right now, so I look a little bit like my dad (runners with work clothes…). I can walk fine, and the flexibility in my ankle is getting there. I still do have pain while walking, which I’m beginning to believe has to to with the graft that was done on my tendon, and is also making my leg quite a bit more stiff.

The biggest issue right now is strength. I can’t do a one-leg calf raise, and my limp while walking is not as bad as it was 4 weeks ago, but is still quite visible. I do two-legged calf raises a few times a day, still working the theraband, and I do some light stretching with a towel.

The biggest change was that I switched PTs. The one I had been going to was mainly geared towards older people with back problems, but it was literally on my block, so it seemed a good choice at the time. Since then, I’ve switched to a more sports-oriented facility and I’ve been doing zillions of exercises and getting some pretty serious massage (not nearly as pleasant as it sounds…) on a regular basis and that seems to be helping loads. I also do work on the wobble board and bosu ball, which is pretty awesome. Working on my proprioception is something that I’ve been told will take some time, and the bosu ball and other exercises are meant to work on that.

Right now I’m just focused on getting my strength back to the point where i don’t have any pain when I’ve been standing/walking for extended periods. I was at a wedding a few weeks ago, and I was in agony after having stood for probably about 2 straight hours.

Hopefully this all goes away soon. If anyone has any good tips on strength building or good calf flexibility exercises, I’m all ears!

Thanks guys!

Had my 10 week follow-up with my surgeon this morning. He said everything is going well and I can ditch the crutches (FINALLY!) if I feel comfortable with it, which I absolutely do. He said my scar is getting a little wider than he’d like but it’s no big deal if I just use some aloe cream and keep it from drying out and over time it will narrow to nothing. Apparently it’s a reaction to the stitches below my skin and the aloe cream helps alleviate that irritation. I’m to see him in another month (@14 weeks). He said I can start some two-foot calf raises, but running will likely still be out of the question for the next 2 months or so.

On the PT front I’ve started doing some passive stretching, which feels awesome, and has given me a great deal more flexibility in my leg to the point where I can almost walk with a normal stride. I still don’t have enough power in my calf to really push off with my bad foot, and it also hurts when I try, so I’m going to hold off on really trying to walk 100% normally and keep doing a bit of a check stride thing until I get a little more strength and a little less pain in my tendon/calf. I think I’ll probably use a cane for the next few weeks and see how that goes, just to be safe. Don’t want anyone knocking me over on the subway or on the sidewalk.

Otherwise, everything is going pretty well. My PT has allowed me to do some light biking on the recumbent bike at the gym, no more than 30 mins at a stretch, at the lowest setting, which while boring, definitely strengthens my calf in a way that other exercises don’t.

Oddly, the site where they harvested my plantaris tendon tends to act up more after exercise than my main incision, which I find strange, but whatever. I think it’s just in a weird, tender spot. Sort of on the meaty part of my calf, just to the inside. My PT has also just given me the go-ahead to stretch myself out a bit too, using a towel or belt to stretch my achilles, but only with my knee bent, propped on a pillow or something. Aside from that, I suppose things are going as well as can be expected. Trying to fend off these fools who are trying to bill me thousands because they bungled the medical billing, but otherwise just fine.

I wanted to make an awesome recommendation, by the by. It’s been mentioned on this site before, but I used a compression sock for about two weeks to keep the swelling under control and it worked like a charm. I bought the futuro brand right from the Rite Aid on the corner. The model was less like a sock, and more like a really thin ankle brace that was surprisingly comfortable to wear all day. The toe and heel were open, and it gave just enough pressure and support that it really helped me as I was beginning to walk again. Also, as I was only really in my walking boot for maybe 4 weeks, it luckily doesn’t stink and is pretty clean, so if anyone wants it…it’s in pretty good shape and I’ll sell it to you cheap if you need one. I’ll clean it and repackage it of course. I also have a night splint that I didn’t use too much either. And these DAMN CRUTCHES. If you need them…they’re all on offer.

Hope you’re all doing well.

Be Aggressive

June 21, 2009 | | 4 Comments

As I’ve mentioned on this site before, I suppose I’m on what can only be described as a very, very aggressive rehab protocol. I was PWB as tolerated from Day 1, and have been FWB, for about two weeks now. From what I can discern, the general consensus is that one’s AT doesn’t fully “set” until between 8-12 weeks post-op, and from what my surgeon has told me, the way they did my surgery (plantaris tendon graft) they repair is very strong, so it can withstand the early weightbearing.

From reading around this site, it’s become pretty evident that the difference between aggressive and conservative treatment methodologies is definitely pain level. From what I’ve been reading, folks who start walking after conservative-to-somewhat-conservative treatment regimens seem to be relatively pain-free as they enter the FWB/2-shoes phase of all this.

I don’t know if any other early-weight-bearers or aggressive rehab protocol folks are out there, but as far as my experience goes, I would say I’m in slight pain pretty consistently while walking. Obviously, the issue is my AT is very tight, and the forward part of my stride definitely stretches my tendon.

As I said before, my doc gave me the option of the boot OR the crutches and just a good pair of shoes, which will actually strengthen my calf muscle faster, according to him, due to the increased usage versus the boot. So I’m not doing anything that isn’t permitted, but I suppose I just am not sure how things should be coming along. I’ll be 8 weeks post op on Wednesday, and I’ve started doing the recumbent bike in PT and it feels GREAT, so hopefully that will get me past this hump and feeling no pain.

Okay guys, here’s where things stand. I’m at 7 weeks post-op, and I have one week of physio under my belt. My doctor told me to stop wearing the boot, switch to two shoes, but keep on with the crutches. Not so much for actual support, but just to keep people out of my walk walking around the city (NYC) to prevent accidents/spills.

So far, I’m pretty sick of crutches. I’ve been on them for about two months, but the doc is right, they do keep people from bumping into you. So far, physio is maddening. The problem I, and I’m sure most of you have, is that my achilles is incredibly tight, but for the first four weeks I’m only on strengthening, and very mild passive stretching so I can’t really walk correctly nor can I push of much with my injured foot, so my limp is pretty pronounced. For awhile I was kicking my bad foot out at an angle so as not to rotate too far forward on my achilles, but now I’ve been trying to get more of a heel-toe pivot on my bad foot. Hurts like hell, but it feels better. Also, now my heel has begun to hurt a lot for no apparent reason.

It walks

June 10, 2009 | | Leave a Comment

Alright folks, just got back from my six week follow-up with my surgeon. I am allowed to walk around town with EITHER the boot OR the crutches, but I no longer need both. At home/in the office, I can walk without either. My doc said that the crutches just tell people to give you a wider berth while walking around town, so they’re a good precaution, and he urged me to use the boot less frequently as walking without it will help me build strength faster. I have my first appointment with my PT tomorrow night after work, and I’m hopeful that I can start getting some flexibility back, as right now, my foot can’t really get much past 90 deg. Maybe 5 deg. if that. Anyway, thanks to everyone on this site for the support. There’s still a long way to go. My doc said we’re still looking at Labor Day for my first day back on the court, so any NYC squash players out there want to play? In all honesty, I’ll probably just stick to running or cycling for awhile before I jump back on the court. Any serious squash players out there have any tips for rehabbing your game after you rehabbed your achilles?

About two months before my injury I had planned a get-together with some of my buddies from high school. We were all going to go down to Philly and have a a weekend on the town. After I had my surgery, the lads weekend hung in the balance. After 4 weeks of not too much movement, I was PWB at the end of week 3, and could take short walks around the apartment and down the block without crutches. I was relatively pain-free. I took a 4 block walk at 4 weeks post-op that did inflame things a bit, but then I stayed off it for a few days and was back on top. Since my doctor told me to use pain/swelling as a guide, I was doing pretty well. I decided not to scratch the weekend, and went down to Philly this past Friday. That night, I used a cane. We didn’t do too much walking. Maybe 1-2 long blocks - 40-50 yards or so. I was mostly in cabs and only used the cane/boot to maneuver to and from the cab/bar. Once inside, I was sitting for the night save the occasional trip to the bathroom. I woke up the next morning and immediately iced my leg, as it was feeling a little bit tender, and jumped back on the crutches for saturday.

That night, fearing I’d done too much, I was back on the crutches again. My doctor was very adamant about the early weight bearing, and things seem like they’re going just fine right now, however my ankle does swell up pretty good when I’ve used it a lot. Also, the days before I started putting any weight on my ankle, I had quite a bit more flexibility in my ankle. Now that I’ve begun to use it a bit more, with the boot on, of course, it feels like it’s quite a bit stiffer. Did anyone else have this experience? I had tight muscles/tendons to begin with — perhaps abnormally so — but the tightness in my heel/calf is a little concerning. I’m going to stay off it this week and see how that goes.

Also, I feel like I have been given a freakishly aggressive rehab timeline: walking boot at 90 degrees from day 1, very mild PWB while i was about 10 hrs post-op (though I didn’t put any weight on it until about 2 weeks), and basically given free-reign to continue PWB until it hurts. No guidelines as to how much weight to bear, just as much as I can bear, which has varied over the past week and a half. I suppose I trust my surgeon, but its just a little nervewracking reading about everyone else on here who basically have been off their leg for two months. I guess I just feel like I must be doing something wrong or cheating and it makes me worried.

Here’s an article by my surgeon about the procedure:

Achilles Article Achilles Article ziffy

Publish at Scribd or explore others:

The Story So Far

May 28, 2009 | | 5 Comments

Hi folks. I’ve been reading this blog with great interest, so I figured I’d start my own. So, here’s my story so far. Full rupture on 4/27/09 playing squash. I loaded up my left leg to spring out for a rail shot down the forehand wall (I was on the backhand side) and as soon as I unloaded, SNAP! They wheeled me out in a wheelchair and I got a ride to the ER. I had recently just had a partial hamstring rupture in my right leg which healed up in a few weeks, so at this point, I wasn’t sure what was going on.

I arrived at the ER and waited quite awhile to see someone. Gotta love the NYC hospitals. I finally was let in, the ER doc came over I described what happened, and she said okay, gave me some pain meds, and then left. She came back about 40 minutes later to really talk. I explained that I felt a snap, and then couldn’t walk at all and she goes “Oh, you’ve ruptured your achilles tendon.” Guess I should have mentioned the snap sooner. She did the thompson test, and asked me to push on her hand with my foot, which I couldn’t do, so she sent me for an x-ray to make sure that the tendon hadn’t pulled off any bone when it snapped.

I came back from the X-rays and the ER doc said they’d sent for the orthopedist on call, but he would be awhile. So I waited. She brought me some of the nastiest food I had ever seen in my life, but given the fact that I’d been playing squash for 2 hours and hadn’t had anything to eat or drink since then, I basically inhaled it. I couldn’t tell you what it was. Maybe pasta, maybe vegetables, but it didn’t look like either of those things. Anyway, the orthopedist finally came around, examined me further, and concluded that he was about 98% sure it was an achilles rupture, but wanted to send me for an MRI just in case. He wrapped me up in a back-slab cast with my toe pointing down, and sent me home with a prescription for an MRI, percocet, and an appointment with the orthopedic surgeon.

The next morning, I went to get my MRI. Naturally, they put the MRI machine as far from every entrance as possible. Anyway, finally had my MRI and went home. The next day, MRI in hand, I went to see the orthopedic surgeon. After another considerable wait, his fellow came in to talk with me, and frankly he was pretty brusque. I know these surgeries are really boring to orthopedic surgeons, but he wasn’t the nicest guy. He gave me the rundown of my rupturemyrupture2, seen here. The white part is the fluid that filled up between the two ends of my tendon, and the little french-fry looking end dangling in all that white stuff is the lower end of my tendon. Apparently, a lot of people who get this injury have the rupture occur where the tendon meets the bone, closer to the ankle. Mine was about 1/4 of the way up the back of my calf. When the surgeon finally came in, he took off my cast to have a look at my legs, and the first thing he says is “Have you always had big, thick calves?”

“Yes, always.”

“Well, here’s what happened. Most people’s achilles tendons are about this long,” he holds his hands about 10 inches apart, “but yours are about this long,” he holds his fingers about 5 inches apart. “Your calves are so big, they basically overpowered your tiny little tendon. After all this is done, you might want to see about getting the tendon in your other leg loosened, we do it all the time.”

This was my first cause for alarm. He was recommending a surgery that was completely irrelevant to the one at hand. Anyway, he went through the process for how they repair it and everything, and once we were back on solid ground, I felt a bit better. He scheduled me for surgery the next week, sent me home in an aircast with a night splint which is what I could wear at night after the surgery . I called my mom that day, told her what was up. Apparently an old friend of hers was an orthopedic surgeon, and she’d made me an appointment to go see him that same day. Gotta love  moms. So I headed in to see him with my MRI, and he had a look. He was much more casual and comforting about it all. He said the procedure was simple, and since I’m an active person, he would do a tendon graft to make sure the tendon stays strong and that I can return to vigorous physical activity. His general demeanor, kindness, and serenity about the whole thing made me feel very good. He himself was a hip specialist, but had been operating for something like 30 years, and assured me that this surgery was “bread and butter orthopedics” after I questioned him about going to a whole bunch of other places to get it done. So, I made an appointment with him for surgery the next day!

The next day at the hospital, I had a bunch of blood tests and filled out a bunch of forms, changed into a gown, had my IV started, and was wheeled towards the OR. I forgot to mention that I had decided to go for an epidural anasthetic. The deciding factor for me was the shorter time to feeling like you weren’t on crack, so I opted for that. There were also other benefits which I’ll describe later. Anyway, I waited for awhile because there was a big liver transplant going on in the OR that day, so there were more rooms booked than usual. After awhile, I got cleared to go. They rolled me towards the OR, and I could see the ORs where they were doing the liver transplant, but couldn’t see in. Pretty cool! So, they stopped me outside the OR, I had a chat with a few of the surgeons and they wheeled me in to the OR. It was pretty cold in there, but not uncomfortably so. They explained everything they were doing at the time, and they had me flop over on to the operating table, face down, they started my epidural catheter which was uncomfortable but not painful, then had me lie down. They then began to start the nerve block. That was a bit painful as they were poking around on my leg to find the right nerve, but it wasn’t unbearable. They said it would get less painful as soon as the sedatives started to kick in, which was basically right away. I drifted off to sleep.

When I awoke, I was groggy, and a little confused because of the meds, but generally pain-free. They had actually just strapped me back into the aircast at 90 degrees, no wedges or anything, with a lot of ACE bandages over my calf and ankle for support. They wheeled me to the recovery room where I was going to spend the night. They had to de-catheterize me, which I will say is very uncomfortable. I got settled, and the nurse introduced me to the button. Oh the button! See, with the epidural, it’s basically a tube right into your spinal cavity, so the button is connected to a pump that sends a measured amount of painkiller directly into that cavity, and kills all the pain from your waist down. It also kills most sensation too, which has the unwanted effect of making you piss yourself a little bit now and again, but it’s a small price to pay for being pain free. After that, I had something to eat, then took a sleeping pill, and woke up in a bit of pain the next morning. Clicked my button, and all was right again. As soon as I woke up they started getting me ready to go. I was made to pee a few times (had that covered, basically) and they had me up and moving on the crutches. I saw a physical therapist on how to use the crutches (pretty unnecessary, since I’d been on them for 3 days or so) and an occupational therapist to ask me a bunch of questions about my job (totally unncessary, but she was cute so whatever). Then, I flopped myself into the wheelchair, grabbed my stuff and wheeled my way home. The PT guy told me I could put a little bit of weight on it right from the get-go, and I basically said to him “you’ve got to be kidding me!” because of the pain, but he said I could put a little weight on it when I was ready. More on that later.

p1060178Anyway, I headed home and the first week was pretty uneventful. Lots of movies and percocet. They do constipate you, so I was taking every laxative I could find. I started working remotely mid-way through that week, which was probably a bad idea. I saw my surgeon for my 1 week follow-up. He removed my stitches (left) in place of steri-strips, and told me to start putting as much weight on it as I was comfortable with, and if it started to swell up, I’d done too much. I basically said the same to him I said to the PT a week earlier, and crutched out with instructions to see him again in 6 weeks. My mom had been around the whole first week to help me out, which was good. She left that weekend.

The second week was good. I ditched the pain killers at the beginning and switched to extra strength tylenol (which does contain caffeine, fyi, so just don’t take it too close to bedtime). More movies. Not too much movement. Tried to go for a crutch somewhere at least once a day. I was switching to the night splint from my boot at bedtime at this point, so it was nice to get a little air in there.

At the start of week three, I began to put a little weight on it with the boot on. Not much. Just a bit. Half a step here and there. I could make it a few steps before feeling weird about it. By the end of the week however, I could walk around my house with only my fingertips on my crutches, and it felt great, so I decided to see how far I could make it sans crutches at the end of week three. After doing a few test laps around my apartment,  I walked to the drug store (2 NYC blocks) and back, then to the sandwich place (3 blocks) and back, for a total of about 10 blocks, but not all at once. Mentally, it was a triumph, but  this was probably too much. The next day, my leg was feeling pretty tender, and so from that point on I was back on the crutches. It swelled up a bit after that, and has felt tight ever since. I’m a little worried I did some damage, but the pain isn’t really at the site of my repair, it’s a bit higher in the unaffected tendon.

Here I am at the end of week 4, and because of being a little overzealous, I have pain where before I didn’t. I guess it isn’t anybody’s fault really. I wasn’t in any pain until the next day, and the swelling is getting under control now, but I do feel twinges of pain every now and again. For those of you out there who have made it past 4 weeks and were early weight bearing, were you in pain once you started to walk in the boot? Did you have swelling the next day? Is that “normal?” I guess I don’t have much of a point of reference for what’s safe because so many people I read about are still in casts at this point (not to poke fun, just saying) so I haven’t really been able to find out if I should be 100% pain free after walking at this point or if pain is normal, or if it’s indicative of further damage. There was no snapping or popping, just tenderness in the tendon and now it’s a bit stiffer than it was before, but no worse for wear beyond that. Anyway, I have my follow-up with my surgeon in two weeks, so hopefully I’ll get some more answers then.

Hang in there everyone!