Monthly Archives: May 2012

A Tip Of The Hat

This guy has some good (and humorous) tips on things that are useful whilst you have an Achilles injury:

http://meandmyachilles.wordpress.com/2011/05/09/top-tips/

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Bootylicious

My foot after 6 weeks and in the boot

I had my 6-week appointment at the hospital today (6 weeks since I had it operated on). I’m on schedule and have moved from a cast to an aircast boot. Looking at my leg today it has definitely shrunk in terms of muscle, but it will be fine to put back on when I get more active again. I was expecting a bit more progress than I got at this stage, but the prognosis from the consultant is to be very cautious.

I had the cast removed and asked the doctor if I’d be OK to return to work now I have this boot. He said no, I needed to stay off for the next 6 weeks whilst I’m still recovering, but I asked him to add to the sicknote that I can work from home on a laptop, so that is what I’ll be doing from next week. He said that mobility wise I’m not going to be able to get to and from work, and get around whilst I’m there. On a positive note he said the stitches are healing/have healed well, and then the plaster technician fitted the boot with 3 wedges initially, removing one every two weeks. In terms of partial weight bearing, which I can now do, the doctor said that I can put 10-15% weight on my foot when I’m up and it’s in the boot – but I have no idea how much this is in real terms so I’ll see how I get on over the next few days.

I then went to see the physiotherapist for the first time – this is where I thought there would be more to do. But she said at this stage post-operation it is still very sensitive and risk of re-rupture is very high if I try to do too much – and she kept pushing the point that I must take it easy. She told me to wiggle my toes daily and bring them forwards and backwards (but not too much), curl my toes inwards and outwards, and slowly bring my ankle up and down too so that it doesn’t stiffen up. This needs to be in very short motions and doesn’t feel like much, but I’m going to do what I’m told as I REALLY don’t want to mess it up.

I can have it out of the boot if I’m sitting down with my foot up, which is nice to let some air get to it and not have the heavy weight on my leg (the boot is heavier than all of the casts I’ve had!). I’m not sure what they said about showering – I think I can shower it now but I’m going to call them tomorrow to check. I would need to sit down in the shower – would be interested to hear what everyone else has been doing. I don’t have a shower over the bath, we’ve got a separate shower. I’ve had a bath every day for 7 weeks with my foot in a black bag, and it’s getting a bit tedious now to be honest. As you can see from the photos above, my foot is pretty dry after 7 weeks in a cast. That’s going to take some cleaning!

The other photo is of my Robocop boot – the little blue pump is what you can use to inflate/deflate the boot to make it fit more/less tightly as you wish. From early experience, I don’t think I’m going to have it inflated too much. The doctor said that every time I move I must have the boot again – and similar to the physiotherapist, he was very forceful with this point. If I fall on it, game over.

It feels like a lifetime so far but the doctor pointed out that in the scheme of things, I’m halfway through what is a 12-week rehabilitation, with physio carrying on after that for some time probably.

I have another appointment in two weeks with the doctor to have a wedge removed from the boot and wounds checked, and another appointment the day after with the physios in the hospital gym. I’m hoping the physio will be stepped up quite a bit at that point, but they seem to be taking it particularly cautiously at the moment. I’m just going to do what I’m told as I don’t want to make it worse. The physio said to just look at it as a series of steps and don’t look beyond the next appointment, and it will make things a lot easier.

4 Weeks Post-Operation

Went back to the hospital today for my 4-week post op appointment. Had to wait around for a good 2 and a half hours before I eventually got seen, and it took about 10 minutes to remove the old cast, move my foot up to ‘plantar grade’ (pretty much as far as it will go) and put the new cast on. Again, it hurt, but probably not as much as last time as it was half way there already. My leg is definitely starting to waste away now, I’ve not seen it as thin since I was about 11 years old, and my foot is very dry and a bit horrible by the looks of it.

I go back on 24th May now for my next appointment (the 28th, in 2 weeks time when I should be going, was full). That’s when I’ll get the air cast boot hopefully, and can start bearing some weight on my foot which will be nice. I should be able to have a shower then too – YES! I’ve had a bath every day for 5 weeks, and it’s a bloody pain! Don’t think I’ll be able to drive with the boot and will still need to use crutches for the 6 weeks that I have it, but hopefully will be able to rely on the sticks less as time goes on.

2 Weeks Post-Operation

I had my first post-op appointment with the hospital yesterday, to have the wounds checked and my cast removed. It took a while at the hospital as they were running around an hour late. It was a relief to get the heavy plaster cast taken off that’s for sure!

The nurse checked the wounds and said she’d never seen a scar like mine before (which at first is a bit of a worry when you hear!). My operation was done using percutaneous surgery, where several small incisions (in my case three) are made horizontally,  as opposed to one long cut vertically down the length of the Achilles. Having read up a bit on this before the op, I believe that the smaller incisions mean that the wounds will heal better and are less likely to get infected, but there is more chance of nerve damage doing this type of surgery than if it was done using open surgery. Some scientists believe that re-rupture rates are higher in those who have percutaneous operations, but newer studies tend to suggest it’s similar whichever operation you have.

It turned out that the surgeon has been doing it that way for 2 years but the nurse had never noticed – hmmm.

I thought that a semi-equinus cast would mean a shorter one than the current full-length cast (up to my knee), but it actually means that my foot should be pointed halfway between pointing at the floor (as it was after surgery) and at 90 degrees to my shin. You probably already knew that, but I didn’t! So it’s still a cast up to the knee.

The nurse pushed my foot up to between 75° and 80° to put a new lighter cast on, and that hurt as the Achilles was being stretched for the first time since surgery. I went a bit pale apparently! I’d suggest taking some painkillers before you go to the hospital if you can – I haven’t taken any for over a week. I have to go back again in another 2 weeks when it will be moved to 90°, and then 2 weeks after that it will be swapped for a plastic boot which I will have for 6 weeks.

It’s been a long 3 weeks so far I have to say, and the hard work will really start when I have to start physio in 4 weeks time.