This Monday, October 1st, marked eleven weeks since I had surgery to repair my ruptured Achilles tendon. At my follow up visit with the surgeon, he looked at the incision scar and seemed impressed at how well it’s healed. He said this is how it usually looks for patients after a year of healing. I guess there’s no way to know how much of that is just how my body heals and how much is due to my physical therapist working the scar tissue with his IASTM torture device (joking).
Day 63 post-op: back to the office
This past Monday, Sept 17th, I finally returned to the office, after almost 11 weeks being out. I was on long weekend (July 4th) when the injury occurred, and worked from home the following week. I then had the repair surgery on July 16th, and spent about two weeks just sitting on the couch recovering – WFH wasn’t really an option for that, since I had to keep my leg elevated above my heart. Since then I’ve been working from my home office.
First of all, let me say how amazingly lucky I am to have a job and a manager that allow me to work from home. I am extremely grateful for that. However, while there are definitely advantages to working from home, it’s not ideal, so I got clearance from my doctor and went back in this past Monday.
I live on Long Island and my office is in Manhattan, which means commuting involves driving to the local train station, parking there, taking a train into Manhattan, and then taking the subway to get to my office. Competition at the LIRR parking lot is fierce, and if you’re not there by 7 AM you likely won’t get a parking spot. I left the house at my previously usual time of 6:25 and managed to get one of the last spots in the “good” parking lot. There are no handicapped spots in this lot so I ended up just taking a regular spot, which was about 1000 feet from the stairs. The stairs weren’t too much of a problem, though I am definitely slower climbing them, and double-timing was not an option. I got a seat and the train ride was unremarkable.
I got off at Penn Station and took the escalator up to the concourse. I took another escalator up, and then decided to take the stairs up to street level. Again, no problem, just slow. I walked over to 6th Avenue and entered the NRQ station at 6th & 32nd. This was the first time all day I had to go down stairs, and it was definitely more challenging than going up. The main problem was that the boot was too big for the steps. I took the subway to 5th Ave & 59th Street, just to take a peek at Central Park before work. One thing I noticed walking on the sidewalk was that the slight grade of the sidewalk is very noticeable when wearing the boot. The sidewalks are all slightly slanted downwards, from the building to the street, so rain will run into the street. Normally I don’t notice this, but having the massive flat-bottomed boot bolted on, unable to use my ankle, it was awkward and uncomfortable. I found walking on the right side of the street was easier than the left, so that the boot was lower than my good foot. Not sure if I’m explaining it well, but it was a noticeable issue.
When I got to the office I took the elevator to the 17th floor, where the coffee is, and then walked down stairs to 16, where my desk is. I managed to get special handicapped elevator privileges with a doctor’s note, so I can at least take the elevator to my floor in the future without having to walk down.
For lunch I walked to a burrito place about 5 blocks away and brought it back to the office to eat. That was also a relatively unremarkable experience.
At the end of the day, I left a bit early, since there’s no way I can run if I need to catch my train. Descending the stairs into the subway station near the office I started to feel sharp pains in my right ankle – my non-injured one. By the time I got off the LIRR and got back to my car the pain was becoming more frequent. My immediate guess was that all the walking down stairs had caused Achilles tendinitis in my right leg. I had a physical therapy session right after work and I told my therapist what happened and he massaged the right leg as well as the left, using his roller thing. He said the right calf was extremely tight, and I need to make sure to stretch the calf out before doing anything, to avoid future injury.
The pain in the ankle continued intermittently throughout the evening, and when I woke up Tuesday, laying in bed, I felt it continue. It felt like someone had slashed the very bottom of the back of my ankle with a razor. I decided to work from home rather than exacerbate whatever the issue was. By Tuesday afternoon it was fine, but I chose to work from home for the remainder of the week. There are just too many steps involved in getting to & from the office. I plan to go back in either tomorrow (Friday) or Monday, and see if I can take a different subway route that has escalators or elevators the entire way.
Day 45 post-op: started physical therapy
Had my first physical therapy session today. The doctor’s prescription said nothing past 0 degrees planar flexion so there wasn’t a lot they could do, but they did a pretty good massage on the calf and worked the scar tissue a bit, and gave me some basic stretching and exercises to do. Rocking the foot front to back, side to side, and around in an orbital motion, as well as scrunching up the toes. Nothing really special, but I guess it’s progress.
Day 38 post-op: no more wedges
Had my “6 week” followup with the surgeon today. 38 days isn’t really 6 weeks, but due to some scheduling issues this is as close as I can get. He took off the last strip of tape on the incision and declared that healed. Most of the scabbing has fallen off and it there’s just a scar there right now.
He had me remove the last wedge from the boot, and also had me stand on the floor without the boot on for the first time. It felt a little weird, but no pain. It definitely felt tight if I bent my knee a bit, and he said it looked like there was noticeable loss of muscle mass in the left leg as well.
He said I can stand in the shower now, which is a relief, but I can’t move the ankle past 90 degrees. He wrote me a prescription for physical therapy and said to follow up with him in 6 weeks, so I won’t see him again until October.
Pic from this morning (pre-doctor) below.
Day 25 post-op: walking again (sort of)
Had my second post-op followup today (August 10th, 2018), 25 days after having Achilles’ tendon rupture repair surgery. The doctor took the tape off the incision, said it was all closed up but there was still a part that was “soft” so he put a strip of tape back on.
He told me I could now get the area wet, as in “run water over it,” but not rub or scrub it. So showering is slightly less of an ordeal now, since I don’t need the cast protector.
The big news though is that he had me remove one of the pieces of the wedge in the boot, so it’s only about 1.75″ tall now, and said I should start walking on it. Obviously with a big wedge in there, I can’t walk normally, but it’s a huge improvement in quality of life to be able to walk up the stairs versus going up butt-first or on crutches.
He also said I should take the ace bandage off when sleeping. I told him I had found another boot on Amazon that’s much lighter – it’s for plantar fasciitis – and I’ve been using that to sleep. He said that puts the foot in the wrong position, and I told him I rigged it up so the wedges were by the heel rather than the toe and he seemed slightly impressed. He said, “you’re an engineer, aren’t you?” I laughed and said yes, and he said “I love it when my patients solve their own problems.” This boot weighs maybe 1/10th what the heavy duty boot weighs, but can’t be used for walking at all. I use it only for sleeping – it’s way more comfortable than the big boot. My sleeping boot is the “Plantar Fasciitis Night Splint by Vive” and comes with two wedges. I’ll add a couple pictures below showing the Vive boot vs the heavy boot (the heavy boot was provided by the doctor, and appears to be this one: Procare MaxTrax Air Walker).
I have some more pics below of the incision with the tape off. Apologies again if it’s gross (it is).
Day 10 post-op: got the stitches out
Today was my first followup visit with the surgeon after the surgery. Apparently everything is going well. He took the stitches out, but said the wound isn’t completely closed at the very bottom, so no getting it wet for a while. He gave me the Thompson test again and a couple other evals and said the tension was back in the tendon. Still can’t put any weight on it for another couple weeks. He took the dressing and cast off and wrapped it in an ace bandage and then had me put the boot back on. Not much to report, but I guess it’s good news, all things considered.
Some pics below, sorry if they’re gross.
Day 5 post-op: taking a shower
I’ve always been a big fan of hot showers. I used to use up all the hot water every day when I was a kid. Not being able to take a shower post-op has been one of the more harrowing aspects of this ordeal. Fortunately, there’s the Curad cast protector. Basically, it’s a plastic bag you slide over your leg and cast, enabling you to take a shower without getting the thing wet. It’s not easy, but at least it’s possible. Also, highly recommend a shower stool or something similar. I don’t know how else you can possibly shower with only one leg. It’s enough of an ordeal that I don’t know if I’ll be able to do every day anytime soon, but at least it lets me feel like a normal human being.
One thing I don’t (yet) have in my shower, but wish I did, is one of those safety bars. Once you find yourself needing one of these, it’s hard to understand why all showers don’t have one. I find myself doing a lot of unsafe balancing on one leg or holding on to the shower fixture or other less-than-stable things. I can balance on one leg, but balancing on one leg in a soapy shower is a different story.
Day 4 post-op for Achilles’ tendon repair surgery
Today’s Friday, 7/20/2018; I had the operation on Monday. I made a couple Youtube videos before and after the operation describing it. According to the surgeon, it went well. My leg is in a dressing from just below the knee to the tips of my toes, which it will be in until my followup visit on July 26th. At that point I expect to get another full-calf dressing/cast. I can’t put any weight on the left leg at all, which has been fairly annoying so far. After ~3 weeks I should get transitioned to the boot for another 9 weeks.
Here’s the videos I have so far:
Monday is the day
Today is a beautiful Saturday. My stupid injury happened a week ago today. I spent this past week visiting doctors and getting ready for the repair surgery. I worked from home as much as I could, but it was hard. I’m not really in any pain but lack of mobility has already taken a toll emotionally. I hate commuting but I like being at work.
I’m supposed to be at the hospital at 12:30 pm. The surgery will begun around 2:00 pm. It takes an hour and then there’s the recovery time, so I should be able to get home around 7 or 8 pm. I’m not too worried about the surgery itself, more the long recovery. I’ve never had a cast on my leg, and even this past week with the boot I’ve been able to hobble around and put weight on it. Post-op I’ll have a cast on for about 3 weeks where I can’t put any weight on it at all. That’s kind of terrifying at this point.
I took a shower this morning, tried to bask in every minute of it, as once I have the cast on it will be difficult or impossible to do. I bought some waterproof cast protectors but just entering and exiting the shower seem daunting one-legged.
Before I got in the shower I took some pics of my foot, to remember what it looked like before it was cut up. A big bruise has developed on the inside of my heel, which seems to be common for Achilles’ tendon ruptures.
The results are in
MRI-3T LEFT ANKLE NON CONTRAST
HISTORY: M25.672 Left ankle stiffness M25.572 Left ankle pain
TECHNIQUE: MR imaging of the left ankle was performed without IV contrast on a 3.0 Tesla high-field wide-bore magnet.
COMPARISON: None
FINDINGS:
TENDONS/MUSCLES: There is moderate Achilles tendinosis with a high-grade tear at the myotendinous junction. There is no full-thickness discontinuity however fibers there is marked laxity of torn fibers at the myotendinous junction. Additionally, there is a second site of interstitial and superficial tearing comprising 30-40 percent of the total tendon surface area along the course of the distal tendon spanning a length of 4 cm up to the calcaneal insertion site. There is no muscle atrophy or intramuscular edema.
LIGAMENTS: The syndesmotic, deltoid and lateral collateral ligament complex is intact.
BONES AND CARTILAGE: The talar dome and tibial plafond are intact. There is no evidence of tarsal coalition. The cartilage of the tibiotalar, subtalar, calcaneocuboid and talonavicular joints is preserved.
JOINT FLUID: There is a physiologic amount of joint fluid. No loose bodies are identified.
PLANTAR FASCIA: Intact.
NERVES: Unremarkable.
TARSAL TUNNEL: No masses.
SINUS TARSI: Fat signal within the sinus tarsi is preserved.
SUBCUTANEOUS TISSUES: There is mild subcutaneous edema laterally and posteriorly about the ankle.
IMPRESSION:
High-grade tear of the Achilles tendon at the myotendinous junction with markedly lax fibers but no full-thickness discontinuity. There is a separate site of partial-thickness tearing along the distal aspect of the tendon.
ICD 10 –
Achilles Tear, S86.012ASigned by: MD
Signed Date: 7/9/2018 2:17 PM EDT
Evan Hoffman's Blog 