The Story So Far

May 28, 2009 | |

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!


Comments

5 Comments so far

  1. Rudedog on May 28, 2009 11:00 am

    Hi Ziffy,

    Glad to hear that you are mobile. Just thought I’d give you my story on pain and walking. I was placed on what can only be described as “very conservative - to fairly aggressive” protocol. I was placed in three different casts NWB for a period of 6 weeks post-op and after this period the consultant basically discharged me to the physiotherapist and said I can go into two-shoes (with heal-gel inserts) FWB. I am now approaching 11 weeks post-op and have been walking for about 30 minutes+ per day (with a limp). I also cycle for about 20 minutes a day and do the cross-trainer for about 10 minutes every alternate days. In addition to this I do my physio exercises fairly religiously. With regards to pain - I still experience pain (especially near the heal) after walking/exercise - however, this is improving on a daily basis. The muscles in foot basically need to be retrained to walk. In my opinion - regardless of whether you are on an aggressive or fairly conservative approach post-op - the time to full recovery is long and patience is required.

    I think the key is to listen to your surgeon/physio and to your own body. These guys have the experience and at times it may seem OK to rush/speed things - but this may/can be detrimental to recovery. I also think it’s good to ask your surgeon/physio as many questions as possible.

  2. peterh on May 28, 2009 12:00 pm

    Hi Ziffy,

    Everyone’s body seems to react differently. For me, I had almost zero pain throughout the whole ordeal, other than the night after surgery. I started walking in the boot at 2 1/2 weeks post op (when I recieved the boot), but felt like I could have started a week earlier. I had very little swelling after the first week. However, my body doesn’t seem to swell much in general compared to other people’s. When I sprain my ankle or something, there is really not much swelling. Other people’s ankles seem to “balloon” with the same injury. I guess everyone is just different.

    Also I think maybe the reason you may have had more difficulty walking is that you didn’t get any heel wedges. For me, I started with about 4″ under my heel. It was the only way that my tendon would not take any load at all while walking. If you’re eager to ditch the crutches, I would suggest adding some wedges under your heel when you go out on your feet.

    As said, either way the long term recovery will be similar, the difference is the short term quality of life and upper left leg strength. But your shoulders will be nice and strong if you stay on crutches!

    Peter

  3. motogirl on May 28, 2009 12:59 pm

    Ziffy

    I was cleared to walk in the boot at 4 weeks post op, and at first chance, I threw down my crutches and took off. The next two days, I was back on the crutches because it HURT! I then “eased” back into walking, and was still sore for a few days, but it hardly hurt at all after a while. I’m cleared to two shoes at 7 weeks, but still used the boot when I’m in a hurry or in unfamiliar territory. My leg swells every day. The Dr said to get used to it- it will probably happen for months. PS- My achilles area has not hurt my during the whole ordeal, but the outside of my ankle and foot hurt a lot, so you’re not the only one!

  4. mattmecs on May 28, 2009 3:23 pm

    Hi Ziffy,
    Good to see a fellow NYer on the site! For one thing, why was your stitches so long? Mine were only 3 inches, but I had the tendon stitched up, as opposed to replaced. I think my guy is fairly conservative. I was in a cast for 4 weeks, and have been in the boot for the last 2 weeks. I am walking gingerly without the boot indoors now, and still have a cankle, but apparently that will take a long time to go away. My foot is still a bit sore every day, but I have to start walking sometime…..

  5. ziffy on May 28, 2009 4:34 pm

    Hey guys. Thanks for the input. I guess my concern is that I think somewhere along the line I was told that 6 weeks post-op is the point where the tendon is basically healed to the point where you can’t really do too much damage to it. I suppose I was concerned that I was doing damage to it when it hurt after my walk, so I hopped back on my crutches and have been icing the hell out of it. I guess I just don’t want to set myself up for failure.

    Mattmecs, I think my scar is so long because they did the tendon graft with my plantaris tendon. I have another incision you can’t see in the picture about 6 inches from the back of my knee where they pulled out my plantaris to reconstruct my achilles. Apparently it’s the procedure of choice for firemen, football players etc. Seems to be working, but I have a pretty sizable lump on the back of my leg where they made the little tendon burrito.

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