Weeks -3 to 0 (this will make sense in a few paragraphs): The three weeks following the incident – I’ll just call it “the cut” were arguably the most stressful weeks I’ve ever been through. I’d had periods of time in my life before when I didn’t know what my injury was, or why I was feeling a certain way, but any emotions then pale in comparison to the last two weeks of November and the first week of December. In the ER that Friday afternoon, I was referred to an orthopedic doctor, whom I saw on Monday morning, the 20th. That weekend – marathon weekend – I pretty much spent trying to not be in pain and distracting myself by going out with friends. I had an MRI Wednesday the 22nd, the day before Thanksgiving. I worked all day every day Friday, Saturday, and Sunday of that weekend with no answers, on crutches in a splint. I hesistated to change my dressing and wrap, because I had a lot of shooting nerve pain down to my foot if I even slightly touched the skin near the outside of the cut, and also because I had no answers and didn’t want to move anything until I did. Sometime over the weekend I managed to chalk up the guts to look at my own MRI disc. It didn’t look like I completed severed the tendon from the images, but the images were also really grainy and I wasn’t used to scrolling through the layers; my last MRI was in 2012 and there were just flat images on the CD. The doctor had written the MRI script for the “right ankle,” and I didn’t question it since I assumed if he wrote it, it would show high enough over the ankle to see the cut. However, it seemed to me like the important part of the image was at the very top, and they just cut it off from view.
On Monday the 27th, the doctor called and said it looked like almost nothing, and I could come in and get a walking boot to use for awhile. I got it and managed to settle my foot into it with a heel lift, but I didn’t feel comfortable walking with it so I continued to use crutches. Sleeping without a splint or boot was stressful, as I still was not convinced the MRI even showed the right area. I called to make an appointment to review the MRI and was snuck in midday Wednesday. To my surprise, the doctor agreed to get a second MRI, this time calling the radiologist to make sure the area of concern (the cut) was marked and seen on the images.
On Thursday the 30th I got the second MRI of the “lower leg.” Stupidly, I figured since the doctor thought the previous MRI looked “like nothing,” this one would show “nothing,” just clearer. So when I got home, I loaded it and looked, and it did not look like nothing. I know a lot of people say they don’t know what they are looking at with MRIs, but I have to say, I do. Especially since I had researched a lot of Achilles MRIs over the past two weeks. I took out the CD and refused to look again. I was terrified and I absolutely hated that I could look at my leg and have no idea what was happening inside. I had no idea if being in the boot versus the splint was detrimental, or if I had done any healing whatsoever yet. I had no idea if I would be better in one month or in six. I had no idea if every passing minute was a step back. If I needed surgery, I wanted to have gotten it weeks ago, and since that didn’t happen, I wanted it within the hour. I just wanted it to be over so I could be put back together and begin to heal.
The weekend of the 2nd & 3rd was rough, as I struggled to find distractions and be alone with my fears and questions. I worked all weekend as usual, still on crutches of course, and a bunch of my friends were out of town so there really was nothing to look forward to. On Monday the 4th, I knew the doctor would call, because he would get the report. I’d been told the radiologist who was writing the report was out on Friday, so I figured the doctor hadn’t called then because he had no information. I did a little painting in the morning on the porch to try to calm down and prepare for anything. The call didn’t come until around 4:00 in the afternoon when I was at work. And contrary to what everyone else said (with no real basis besides trying to help me not stress), I was right. I wish I wasn’t right as much as I am. I hate being right. So, surgery was scheduled for Thursday. The first thing that I thought of was my physical therapy school interview that was scheduled for Friday afternoon. Surgery needed to happen Thursday, there was no negotiating that (and I didn’t want to), but I also was not about to let it affect the thing I wanted most at this point in my life, which was getting into school. I could only hope for the best reaction to anesthesia and good timing for the nerve block.
I went to the surgical suite on Thursday the 7th at 8:15 AM for surgery at 9:30. I had a bag packed to be picked up after in my living room (I had to get a ride to surgery because my parents were stuck in traffic, but they were going to drive me home after for the weekend) that contained my interview clothes and prep notebooks, a left shoe for the interview, a bunch of much more comfortable clothing, and my theraband (because anyone can do clamshells post-surgery…why not?). The staff was so efficient and I was in the room-before-the-surgery-room within minutes. I was stressed about the anesthesia because I hate being nauseous more than almost anything, and I felt like that could be a side effect. I also didn’t understand the concept in general of being “under,” as it was my first time and I just didn’t understand how there was something in between being alive and being dead? I admit it is possible I thought about this too much. I could feel whatever they had in the IV hitting me, and that was a strange feeling, almost like those days I wake up in the morning and feel like my blankets weigh fifty pounds because I am still tired. I was wheeled into the room where the surgery happened during this time, and I was surprised that it had a ridiculous amount of natural light from big windows on one wall that faced the woods and the morning sun. They did have me transfer myself onto another “bed” face-down by just rolling onto it, and then I don’t remember anything else. I’m glad they didn’t put a breathing mask on while I was awake. Or count down or anything, that would’ve been strange.
I woke up in the room from before, sitting up. I saw a clock on the wall and it was around 10:20. I was relieved to realize I was completely aware of the time I had just spent in surgery and where I was. For some reason I was really concerned I would say crazy things, be confused, and throw up everywhere. None of these things happened. When the nurse approached me, I simply said that I’d been wearing a headband during surgery that must have come off with my cap, if she could find it for me? Can’t lose my go-to black Sweatyband to surgery! I had some ginger ale, and then she made me sit in a wheelchair instead of crutch, though I felt fine. My head felt slightly weird, but not bad. I was excited about this because it meant I could go to my interview! I doubted I’d feel worse the next day. The nerve block didn’t freak me out too much, as I had a feeling (ha, ha) what it would be like and was just grateful that it was working. It was injected just below the knee, so I could still easily move my leg around from the hip and knee normally. My doctor saw me before I left, after the surgery, and told me that while the MRI made it look like it was a full-thickness, full-width tear, when he actually went in there he discovered it was not full-width, which was really good. He called later that day to repeat that news in case I wasn’t with it when he told me in person. I was pleased by this, of course, but it didn’t really affect what I was going to be doing for the next three or four weeks (being non-weight bearing in a splint), so I didn’t exactly pop some champagne. Nor would that have been allowed.
Weeks 0-2 post-op: The very nice and patient PA who works with my surgeon scared me to death about elevating my foot. I was now paranoid that I would have my foot down a second too long and the incision would burst open and I would have to have another surgery (I should make a list of some of my extreme irrational thoughts I have had throughout this process once it’s all over…). I was also not sure how I would know when it was swollen because I couldn’t really see, and for the first day feel, my lower leg. I was also unsure about the pain killers I was prescribed, because (common theme here) I was nervous they would make me throw up. I was also scared about how it would feel when the nerve block wore off, and if it would wear off before I had my interview. There was just a lot of things at play here I was not experienced with in the least. I am pleased
to say that while I was the last person interviewed within the three-hour block, my nerve block decided to wear off on the car ride home (my friend drove me from Princeton to the school, my mom drove to and from Princeton from home) in rush hour on the Turnpike. During the switch from one car to the other, I put my leg vertical and it did not feel good. There was some pain but also just the awful feeling of blood rushing down and making my lower leg feel very heavy. The next day I watched Army-Navy on a screen while my family was there in the slippery, freezing snow (I wasn’t too jealous that I forfeited my ticket to be honest) and was in quite a bit of discomfort when the meds weren’t at their peak. Sunday I only felt pain in the morning, and didn’t need to take a second dose. I was even able to do some leg lifts, Myrtle hip exercises, core, left leg Romanian deadlifts without weight, and theraband clamshells! I figured staying still for so long was not good either. I had to take aspirin (for the first time in my life, actually) twice a day until I was weight bearing again.
I had the first week off of work because I had the PTO to use. I went out a couple times and kept my foot up when I got to where I was going. I had to go back to work at the start of week two due to the lack of PTO, but I modified things a bit so I could keep my leg elevated most of the day. This often meant making my knee and hip very uncomfortable, unfortunately. I got excited about the little advances, like managing to find pants that fit over the splint – hard to do when I always wear pants with very narrow leg openings…I admit I bought a couple new pairs online because I had nothing.
I did some online Christmas shopping and some painting, but not as much as I thought I would get done. It should be noted, in case it wasn’t clear, that I have not been able to drive since the day the cut occurred. I likely won’t be driving until March.
On December 20, about two weeks from surgery, I went to my post-op appointment, where my splint was removed for the first time. I was nervous but looking forward to this, as I knew it was progress. I was now able to shower without the cast cover (still using the stool to sit of course), and was instructed to do ankle pumps up to but not past neutral three times a day for about five minutes. The first day, I could hardly move it at all. I was unsure how on earth I would ever get to even fifteen degrees plantar flexion, yet alone neutral!
Weeks 3-4: Starting with three days after I was able to remove the splint several times a
day to move my ankle, I noticed a small bubble of fluid on the incision. As usual I got concerned and asked some people about it who would know about such things. They seemed to think it was fine, just a normal thing to happen when I start moving. Over the next week, however, the bubbles started to bleed and dry and harden in cycles, and I just was not sure that was what it was supposed to do, since the lower part of my incision was not doing that and seemed to be healing the way it should. It didn’t help that it was about ten degrees and my skin was super dry. Being outside crutching around with just a sock or two covering my toes, with very bad circulation to the area, was not pleasant, by the way. I called the doctor on Tuesday the 2nd, and went in to get it checked out the next morning. This appointment was not fun. It turns out I had stitch abscesses, which occurs when the body rejects dissolvable stitches and wants them out. The doctor explained that this used to happen often, but better stitches were made and those are the ones they use now. “It almost never happens now,” he explained, “but you’re special.” Not something you want to hear at the doctor’s office. I was already only the third case of an Achilles laceration he had ever seen, and he has probably been practicing for almost twenty years. So, the stitches needed to come out. This was the first time I felt pain since the dull pain that came after the nerve block following surgery. I was face down on the table and he had to dig out the problematic stitches just below the skin on the incision line as well as the sutures that closed the incision on either side of it. I couldn’t see what was happening luckily, but I saw blood on the floor once I was wrapped up. That’s always lovely. I had to go on an antibiotic for the next ten days and shower with the cast cover again. That all happened before a nine hour workday, and I took Lyft to and from the appointment…one of those Wednesdays.
Weeks 5-6: The stitch issue kind of set me back a week at first, as I stayed in the splint now until week five, which was my original appointment anyway. So on January 10, I went back and he said I could wear the boot and ditch the crutches whenever I felt comfortable. I had two heel lifts and I coud start with both and ease my way down to one. The next two days were quite the experience, as it was a huge stretch for me to go from the splint down to two half-inch heel lifts in the boot. I was behind with my range of motion because the stitches leaking made me nervous to move my leg as much, despite the doctor telling me I was fine to still do it three times a day. Wednesday and Thursday, and maybe part of Friday, I had a constant ache in the back of my leg as I was in the two-lift boot setup. It is funny how the body adapts, though. These few days really made me understand this on a new level. Each day the stretch felt less aggressive, and I was able to use just one lift once the pain subsided completely on Friday. It was never “bad” pain, I knew it was just an unfamiliar stretch-pain from being in a new position. I was still using crutches but trying to transition to weight bearing in the boot. Once the pain went away in the one heel lift, I took my first unassisted steps on Sunday morning. Throughout the workday that day, I left one or both crutches somewhere across the store, and made my way around without them. I couldn’t swing my left leg through past my right, though, making me extremely slow. For this reason, I still crutched distances that weekend and the next week, such as to work and anywhere else that was farther than across a room. I was also very accustomed to crutches by this point, so my crutching muscles were conditioned and it didn’t tire me out like it did in November.
Despite not really ever mastering walking in the boot, I was only in the boot for a week, which meant I was technically allowed to be in two shoes at six weeks as the doctor planned. That appointment was on January 17. I had a really full work schedule the next two days, however, and I just needed some time to figure out how to do this and see if it was something I coud maintain all day. On Friday the 19th, I stayed late at work to
patiently try walking in two shoes (with the heel lift) with no distractions or obstacles (and also many things to hold on to if needed). This was an emotional moment, as I ended up walking just as badly as I was in the boot, confirming that it wasn’t the boot that was preventing me from dorsiflexing and following through, it was my body. It was understandable that I would be ridiculously tight and not able to do it right away. It was just crazy to almost forget how to walk normally, and realize all of the small things that made up what we think of as such an innate movement. At work the next day I stayed out of the boot for about seven hours and tried to get used to feeling the ground again. Despite the lack of dorsiflexion, it was a relief to find out that I had no issues with weight bearing, even on one foot for a second.
Getting into two shoes seems like a good place to publish this post and move on to the next! I’m looking forward to sharing what I have been able to do exercise-wise over the past couple months as well as little tips and tricks for getting through the routine of each day, plus musings about physical and mental adaptation.