I can see the light at the end of the tunnel! Well at least see far enough to know that my cast boot will be coming off very soon. The above image was my last game coaching basketball while wearing my cast boot! Three cheers for proper rehab!
As I mentioned in my last update, I delayed removing the third and final Achilles wedge from the boot. Normally, it would take up to a week for the discomfort to settle down, at least this was the case with removing the first two wedges. But after starting more intense rehab exercises and stretching, there was some minor tearing and the ankle pain (near the tibialis posterior tendon) is not settling. So after keeping the final wedge in the boot for an extra week until the ankle pain settled, I have finally removed it! This time, I was much more careful and kept my foot elevated for the first few days after the final wedge removal. This helped quite a bit to keep the tenderness down. Without any wedges in my cast boot, it took a few days for tight muscles to stretch out. I made sure to sleep in the boot to keep the muscles and tendon stretched as it keeps the foot closer to neutral. Without a boot, our feet actually relaxes further away from neutral and thus, shortens the Achilles and surrounding muscles.
Achilles and Ankle Pain
Removing the third and final wedge meant the Achilles is now being lengthened even more and I can definitely feel it. The first day of wedge removal, I decided to use crutches even though still wearing the cast boot. This helped tremendously in decreasing the force of my heel strikes. In a cast boot, the faster you walk, the harder your heel strikes the ground. This causes tenderness and pain on the inside of my injured ankle near the tibialis posterior tendon.
When the healing Achilles is irritated, I feel a burning sensation and sharp slices of pain. But the most pain I have felt throughout the entire 12 weeks of recovery is ankle pain; almost as if it was also sprained when I rupture my Achilles. I have seen other patients post an image of their foot and they also have bruising on the inside of their ankle; I had that too in earlier weeks. But bruising means where blood is collecting and not necessary the site of an injury.
Given the lingering dull pain that I have on the inside of my ankle and that it is still swollen at Week 12 and has been since Day 1, I am convinced there was some soft tissue trauma to this area when my Achilles tendon ruptured and my awesome physiotherapist told me there is a tendon called the tibialis posterior tendon that runs down that part of our ankles. If anything was injured either at the time of the rupture or even post injury due to overuse, it might be that tendon. Thank you Amanda, my physiotherapist, for all the great info!
On some days, my injured ankle feels very tight. Even my physiotherapist noticed my injured ankle had much less movement than good one. This is to be expected given that I was wearing a cast boot for this entire time. The boot locks my foot in a certain position for the soft tissues to heal correctly but at the same time, it will also decrease mobility of the ankle joints. Part of my exercise is to work on the up and down motion (plantar flexion and dorsi flexion) of my ankle. I have been also doing inversion and eversion exercises (side to side movement) but these have been more difficult as my subtalar joint is very stiff. My physiotherapist said she cannot move this joint very much. But with each passing day doing home exercises and continuing to see my physio twice a week has helped this tremendously. I am increasing mobility in my ankle and there is less pain during exercises. My experience during this rehab really shows the importance of finding a physiotherapist that you trust and who really know their craft. And then also being diligent with doing the proper rehab exercises at home. These are the keys to a speedy and proper recovery!
Almost Time to Removing the Cast Boot!
The dull pain in my ankle area and microtearing that I have felt in the healing Achilles has settled quite a bit by the end of Week 12. The cast boot is almost ready to come off. Although I have been wearing this cast boot for about 3 months, I will NOT miss it when it’s time to wean it off. I do know it may mean going back to crutches temporarily for extra support but after doing all the home exercises, I can feel my calf and ankle getting stronger. I actually feel very positive about my recovery at this point and see significant improvement on a daily basis. I cannot wait!
Here is a decently high protein meal for this week. Yes, I do love sushi!