Peroneus Longus Tear: The 4 months before surgery!

Ok, It's been some time since I have last updated, and think it's about time to fill you in on how things have been going, but before I continue I'm going to take this opportunity to back track and give you the history of my injury. So far in previous posts I've explained how I got injured, but I haven't told you about the 4 months before surgery.

First Visit

Initially, the morning I went to the Occupational Medicine Doctor I was told I had a 10% tear in my Achilles tendon, and that I should be able to return to work in a couple of weeks. The Doctor said I didn't need an MRI because it is very difficult to see soft tissue damage on the MRI. He gave me some crutches and told me to sit and do nothing for the next couple of weeks. Absolutely no weight bearing at all. So, this is exactly what I did. It was extremely boring, but I knew I was going to go back to work soon.

Keep Sitting

After returning to the Doctor several times he just kept telling me to keep sitting and letting it heal. The fourth visit I let him know that it was still really bothering me and that it was making it difficult to sleep at night. This was about a month and a half after the injury. He was surprised when I told him how things were going, and he thought maybe this injury was worse than expected. So he bumped the tear percentage up to 15%-20%. Although, still not ordering an MRI.

2 Months of Crutches

I thought I was going to return to work after 2 weeks, and here I am 2 months out with no load bearing and using crutches everywhere I go. Not much fun. I'm glad this injury happened at work because otherwise I would be in the poor house.

Lite Therapy

I Started therapy October 14, 2010. The first couple of weeks I was still on crutches. I was restricted to do very simple stretching. Once I started to make some progress in therapy and could actually put some weight on my foot they decided to get me into work conditioning. My lite therapy session ended on December 9, 2010. I still had to walk slow and had a major limp. If I made a full stride it felt like my tendon was going to pull completely out of my foot. Something still wasn't right, but what do I know! I just kept doing what I was told.

Work Conditioning

Work conditioning is therapy that gets you back into shape for work. They do an evaluation and customize your program based on your injury and the type of work you do. It's basically a workout program you go to 3 times a week. They show you everything they want you to do, and then you are on your own. These sessions usually last 2 to 3 hours depending on how many people are there and how quick you are between exercises. They also do massage and ultrasound after each session. My sessions started December 13, 2010.

My sessions began with riding an exercise bike  for 10 minutes and then moving to the elliptical for 5 minutes. A couple of other exercises included:

• Total Gym - Two leg squats, one leg squats, two leg heal raises, one leg heal raises
• 25 pound single arm curls
• stair climbing
• ladder climb
• balance beam
• ball toss - two leg standing on foam, one leg standing on foam
• slant board stretches - one leg and two leg
• soleus and gastroc stretching 

There are more, but you get the idea.

Making it Worse

I felt like I got run over by a train after the first and second session. I still had a lot of pain in my ankle. I could tell it wasn't getting better, but the Doctor and the therapist said this was normal. I was told the pain may never completely go away. I was in a ton of pain after each session. My workouts were in the morning, and they basically ruined me for the rest of the day and the following day. It wasn't much fun. I couldn't go anywhere or do anything with out pain. Not to mention I limped and walked very slowly. I felt like a prisoner in my own home.

About 2 weeks into work conditioning my therapist introduced me to a new stretch, the soleus stretch on the slant board. This stretch was the beginning of the next chapter of this never ending injury. When I explained to my therapist how I was feeling she began to rethink things. After seeing how I was reacting she could tell I wasn't getting better. So she contacted my Doctor and said I need an MRI and reevaluated.

Waiting Game

Sometime around the first of the year they decided to do an MRI. Once I had the MRI the Orthopedics Doctor I was recommended to couldn't see me until February 25,2011. That was going to be a month and a half of waiting. Ridiculous! My therapist had been seeing a patient that had a similar problem as me. This lady had her peroneus longus surgically repaired, and absolutely loved her surgeon. That's when I caught a break, because this Doctor could see me February 1, 2011. I could stand waiting 2 weeks.

During this 2 week waiting period my therapist thought It would be a good idea to see an orthotics specialist. His name is Bob. He had one look at my feet and said "holy cow you have really flat feet". I've known this my whole life but never thought it would be a problem. Bob said my flat feet are probably the reason why my ankle is not healing. They cause the tendons in my foot and ankle to be under tension all the time. If I were to step wrong this puts even more tension on the injured tendon weakening it and making it difficult for the body to heal.

Custom Orthotics

Bob crafted me some custom orthotics that I thought would be a major pain to deal with, but they actually helped ease the pain a little. Check these things out.

I have to wear these in both shoes, but I don't mind because they actually help. I will get into more detail about the bottom picture later on. These things don't fit into dress shoes, they are to high.

Orthopedics Doctor Appointment

This Doctor is really good. He showed me the MRI and explained everything in it. I went into the appointment  wondering what was going to happen. My therapist didn't think I would need surgery, but this Doctor acted like I already knew I was going to have surgery. He explained in the MRI that he saw some fluid accumulating but still couldn't make anything out as to how serious it was. He said he would have to expose the whole tendon to see what was going on, and that was the only option I had at this point.

He had me do a couple of stretches as he poked around to see where the most pain was. This is when he pinpointed exactly which tendon it was. The peroneous longus! 

Surgery!

Ironically, they scheduled my surgery for February 25, 2011. The rest of the story can be found here  

 

 

Peroneus Longus Tear: The Scar

The doctor said everything is going great, and to keep doing the same thing I have been doing.  He wants to see me back in 2 weeks, Tuesday April, 5th 2011.

I still can't put a whole lot of weight on it yet.  When I do (by accident) it feels as if the incision is going to bust open and the tendon is going to pop out.  Doc said that is a sign that the area and tendon are still healing.  He said to keep testing to see how much pressure I can add each day.  I definitely feel a difference each day, but not very much.

I have been moving it back and forth, but I have only gained a tiny bit more mobility.  The bottom of my foot feels like I have a piece of tape on it, but I think it is because that tendon is so tight still, it's a weird feeling.

The boot has not been on since last Tuesday.  The doctor said the only time I need to wear it is if I go somewhere, but since I don't go anywhere I have been able to keep it off.  It feels so much better to keep it off too.

Also, the butterfly stitches came off so you can see the scar for the first time.  The redness around it will go away with time.  The doctor said that it is healing nicely, and that he is very happy with the progress. Check out the pictures.

Peroneus Longus Tear: Foot comparison

I finally got to wash my hurt leg today for the first time in about 3 weeks.  I feel so much better.  My leg still had an orange film on it from the surgery that was pretty disgusting.  My leg has started to break out with these little bumps that really itch too.  Hopefully they will go away the more I shower. 

I took some pictures of how much muscle I lost in my left leg compared to my right leg.  My right calf is hard as a rock, but my left calf is like jello.  Pretty sad, but that's part of it.

Peroneus Longus Tear: Check-up

Tuesday, March 15, 2011 I had a check-up to make sure everything was looking good, and that the red spot at the bottom of my foot was not getting worse.

As you can tell in the picture, the redness towards the bottom has gone away, but I have developed the red spots just above the incision.  I finished my anti-biotics the day of the appointment, so they seem to have worked.  The red spots at the top are to be handled by rubbing anti-biotic ointment cream on it.  Not real sure if he was kidding or not, but he thought it might be athletes foot.  He likes to kid around, but he wasn't very concerned with the spots.  He said the incision was looking really good, and that the healing process seemed to be going very well.

I can now take a shower without covering my foot up, and the butterfly strips would just fall off on their own.  I don't have to wear the boot to bed anymore.  I only have to wear it when I am up on my crutches.  He wants me to move it a little more and put a little pressure on it.  I can even use a light weight rubber band to add a little pressure.  I can step on it as well.  He said not to over do it though because it is still early on.  If I did too much I would be back in the same boat.  I still need to keep it elevated for the swelling most of the time.

It's been pretty boring since I've had the surgery, because I have been confined to one area basically.  I'm sick of the crutches, any time I get up to go anywhere by the time I get there I am winded.  In other words, I am very out of shape.  I can't wait to be normal again, and do the things I used to be able to do.  I've been off work for the last 6 months, so when I go back I'm going to be like a brand new employee all over again.  I can't wait to get back to work and do manual labor again, sounds crazy huh, but that's who I am and what I do.

Ok enough feeling sorry for myself, lets think positive.  I can now shower my entire body, that's a major positive.  I have a healthy family that has been supporting me through this whole process, I don't live in Japan, I still have an amazing job, I have a nice house, etc.  I think you get the picture.  I'm still in high spirits.  It would take a lot to get me down.  This surgery has gone far better than I ever expected so far.  Here's to a good surgeon, cheers!  I'm out!

Peroneus Longus Tear: Removal of Stitches

My computer recently crashed, and has been in the shop for the last couple of days.  So, I need to catch you up on what has been going on.

Tuesday March 8, 2011 is when I got my stitches out. I was a little worried that this would not feel very well, but wasn't going to let it get me down.  I asked the Doctor how many stitches I had on the inside.  He said he had to cut through the retinaculum to get to the peroneus longus, and this is the only thing he had to stitch back together on the inside.

The retinaculum, are what I would call, the straps that hold everything together.  Kind of like when you have a whole bunch of wires behind your tv and you wrap tape or velcor around them to keep from looking messy.  That is how I picture the retinaculum.  The photo below shows them in white going across the foot.

From what I have read online, when you have surgery on a torn tendon they open you up and suture the tendon back together.  Well, I guess that is not right.  What I was told is that they take this instrument and run it along the damaged tendon.  This is suppose to stimulate the stem cells in your body to come and fix the tendon with scar tissue.  Basically it re-injures that spot so your body notices it again.  The doctor said before this instrument got introduced that they use to take a scalpel and poke a whole bunch of tiny holes in the tendon to trigger the stem cells.  I guess this new instrument does not add more holes to the tendon.  So, there are not any sutures in my peroneus longus.  See, you learn something new every day.

When he took the dressing off my foot he noticed down at the bottom it was starting to turn red a little, so he put me on some anti-biotics just to be safe.  You can see down at the bottom of my foot how red it is.  He pushed on it a little bit, but it wasn't painful, so he said it probably wasn't that big of a deal.  You can see my Dad in the background.  He has been helping me out big time by taking me to my appointments, among a couple of other things.

I am allowed to move it up and down, but nothing to drastic.  It still needs to be elevated most of the time, because it is still swollen quite a bit.  Five minutes is the most I can stand on it at a time.  Pretty much long enough to go to the bathroom and back.

After he left the nurses came in to remove the stitches.  I believe there was 22 or 23 of them.  I was a little apprehensive about this , but the nurses kept talking to me to calm me down.  She asked me how I was doing at one point.  I told her I was fine and if she was going to start taking them out.  She said she had already taken out half of them.  Once again to my surprise I didn't even feel her take them out.  It was awesome, no pain.  After they got done they ended up putting long butterfly stitches on for a little added support.  Then they sent me on my way.

Peroneus Longus Tear: Follow up appointment

I had my first appointment with my doctor today.  Just to change out dressings and make sure everything was going ok.  So far I have had no pain at all, and have not been taking any pain medication either.  I am still sleeping very well also.

I'm not real sure what I was thinking before my appointment, but I thought there was a chance that they might do something to cause some pain.  I decided to take some pain meds, and boy was that a mistake.  I have been out of my head all day long.  It feels like an out of body experience.  I can't really think straight, and I have been extremely tired.  I won't be doing that again.  I think its better to just stay away from the drugs, for me that is.

My dad took me to my appointment today, and he was armed with the camera.  I have been dying to see what my foot looks like since I had the surgery, and finally its here .  I got one pretty good picture the doctor took for me.  I will put the pic at the bottom of this post since some of you won't want to see it.  It's going to be a healthy scar once everything is done.

The doctor said the tear in the upper part of the peroneus longus was a 6 inch longitudinal tear.  He also said the sheath encapsulating the tendon was extremely tight, which would have added to the discomfort quite a bit.  The tear by the knob was a longitudinal tear as well but not as severe as the other one.

At this point I still have to keep my foot elevated the majority of the time because there is a lot of swelling still.  I am allowed to remove the boot and move my foot around a bit, but just don't over do it.  They said after the surgery I can only be on it for 5 minutes at a time, and this still applies.

My next appointment is March 8th at 10AM.  I will be getting my stitches taken out at this appointment, and will be given a little more mobility also.

Well, it's time for the pic. If you get sick to your stomach easy you might not want to look at it.

I think It looks pretty good.  There is a lot of writing on it still from where he marked everything before the surgery.  After the doctor put my dressing back on I got extremely hot, light headed and lost hearing.  I just about fainted, but after a bottle of orange juice and a cold rag I was just fine.  I had not eaten a whole lot before the appointment, so I think this had something to do with it.  I'm fine now, and getting ready to go to bed.

Peroneus Longus Tear: Bedtime and the next day

In my imagination I thought sleeping in bed the first night was going to be very difficult.  It turns out that I slept like a baby.  I got up to go to the bathroom once, which was uneventful.  Hopefully the rest of my nights can go like this.

This morning I woke up at 8:30AM, and felt really good.  As a matter fact I felt so good that I felt I did not need any pain medication.  It's 12 hours later and I still have not taken any pain medication, how awesome is that.  All day I have felt really good, but I do have one complaint I have had the stinking hiccups all day long.  They are about to drive me nuts.

I had another awesome turkey sandwich, and a great chicken and rice dinner.  All thanks to my wife, she has been a huge help doing pretty much everything.

Hopefully things keep going the way they have been.  I am going to keep trying to go without the pain medication for as long as I can.  As of right now I am in no pain at all.

I guess I will update you tomorrow, and hopefully I will get rid of these stupid hiccups.  Later.

Peroneus Longus Tear: At home after the surgery

 I made it home feeling great, but super tired and hungry.  I was craving a turkey sandwich and a sprite.  My wife fixed me up on the recliner with pillows to elevate my leg and an ice pack under my knee.  She also made my sandwich and sprite, tasted awesome.  I kept dozing off while I was eating though.  My parents went to the pharmacy to get my prescription while I napped a little. 

 They got my pain medication, Norco, some Tylenol, Ibuprofen, and aspirin.  The doctor said to take the Norco as needed.  If I didn't need that then I could alternate Tylenol and Ibuprofen.  I am suppose to take the aspirin once a day to help prevent blood clots.  Before the surgery the nurse put a long support sock on my right leg to help prevent blood clots also.  This is suppose to stay on until my appointment on Tuesday, March 1st.

I took the Norco when my parents got back because I figured the anesthesia would wear off and I would be in a ton of pain.  I kept dozing off the rest of the day.  Never in any pain.  My foot actually feels like it did when I went into surgery.  The same dull achy sensation I have had the last 6 months.  I kept taking the Norco, 2 every 4 hours, up until I went to bed at 10:30PM.

I felt pretty good all day considering I had gone through surgery.  My main concern was taking the narcotics, but I have not had any problems at all.  Usually when I take narcotics I hallucinate really bad, so much so that I can't take the meds anymore.

 I almost forgot to mention the awesome dinner my wife fixed, chicken stroganoff in the crock pot.  The chicken was so tender and the sauce was an Italian cheese sauce that was amazing.  She added rice to it as well.  It was so good I had to go back for seconds.

Peroneus Longus Tear Surgery

They wheeled me in and I had to climb up on the table.  I just had a short open backed gown on, which practically fell all the way off.  So, the whole team got to see the whole package before the procedure.  I really did not care at all at that point.  Anyways, how often do you get to be completely naked in front of a bunch of people, and it be perfectly fine.  Never for me.

After I got on the table they set everything else up, and shaved my leg.  They put the oxygen mask on and then the sleeping juice.  I remember someone asking my name and by the time I said it I was out.

I woke up what seemed like seconds later (actually an hour) and felt really good.  I was wide awake and in no pain at all.  The clock said 10:15AM.  The nurse came over and asked me some question, and I think I asked her a ton of questions also.  I really don't remember very well.  I do remember the doctor coming in and talking to me.  He told me he had to make the incision a lot longer than anticipated because my muscle and tendon was a whole lot longer than he had ever seen.  I'm not sure what this means.  I will have to ask at my next appointment.  He said he found a tear where he marked before surgery, and there was also a tear down by the knob on my foot also.  So its a good thing he exposed the whole tendon.

 Once I got back to the waiting room with with my family the nurse gave me an ice cold Pepsi and a nice warm blueberry muffin, which tasted so good.  I got a little nauseous but after a couple of seconds it went away.  They took the IV out and I went to the bathroom. I had no pain whatsoever.  When I got back in the room my wife helped me get my clothes back on and then I was free to go.  On the wheel chair ride down to the car I got nauseous again, but held it in.  I then got in the car and we drove off.  Once we were driving it was apparent that I was going to have to vomit.  Luckily they gave us a bag, because I threw up all the liquid I drank and the blueberry muffin (I felt sorry for my wife having to listen and watch while she was driving).  After the vomiting, which only lasted about a minute or two, I felt like a million dollars.  I have not been nauseous at all since. I have been pain free, but extremely tired.

Peroneus Longus Tear: Surgery day

I had to be at the hospital this morning at 6:30 AM for registration and prep.  My surgery was scheduled for 8:30 AM.  Of course we had a snow storm over night that made it difficult to get to the hospital, but we made it without any events.

 During prep the doctor came in and initialed the leg to be operated on, and circled the spot where the greatest pain was.  He filled me in on the procedure letting me know that he would use stitches instead of staples because they are easier to remove, meaning less painful.  I was also going to receive a soft cast with a walking boot instead of a hard cast like I expected.  He also re-informed me about exposing the entire tendon.  The medication he put me on is called Norco.  The procedure would take an hour, and then I would be asleep in recovery for a half hour. Once I would awaken I would meet with the doctor and then they were going to take me to my family after another half hour. I was going to have to stay in that room for about an hour.  So roughly 3 hours from start of surgery to heading home.

During prep, a student got to experiment on installing the IV in my hand.  It was kind of funny because she kept asking the nurse for diredtion like she wasn't sure of how to do some steps.  She ended up doing an exceptional job.  I told her she did very well, and let her know the horror story of  my last IV insert.  The nurse tried 4 times to get it in my arm, and even broke the needle off in my arm one time.  Her excuse was that I had the toughest skin she had worked with. I find that hard to believe. After that I sat in the waiting room with the fam until 9:00 AM when they took me to surgery.