11 Month Update

It’s been a while since I last updated my blog, so I’ll begin this post with a little backtracking.

In my last update, I mentioned I would be getting a second opinion on my Achilles repair. On August 19th at almost nine months post-op, I visited a highly recommended doctor in Baltimore whom I’d met with the previous summer. After I caught him up to date, he examined my calf, resting tension, and decreased strength, before giving me an uncertain prognosis even less optimistic than the one I’d received from my regular doctor.

calf_muscles_oct_15

The doctor told me there are multiple factors contributing to my persisting lack of strength. Foremost, my calf is still so atrophied that it would need to generate twice as much force to obtain the same results as my unaffected side. After multiple surgeries and months of disuse, regaining that muscle is extremely difficult. Not only that, but the resting tension of my new Achilles is not optimal, which makes achieving that strength even harder, if not impossible. The images below show my resting tension before and after my second surgery.

To address an overstretched Achilles tendon, a shortening operation can be performed. A small section of tendon is removed and the tendon is sutured back together, at which point it fuses back together naturally. However, because my Achilles is not my native tendon, the doctor told me such an operation would not be possible. The foreign tissue in my leg acts in much the same way as a piece of rope would, simply anchoring my heel and calf muscle together. Thus, should a section be removed, the remaining tendon would not heal back together. In order to shorten my tendon, it would have to be detached from my calf muscle, shortened at the top, and then re-sutured to the muscle.

resting_tension_mikhaila_markham

The doctor presented this alternative to me in a way that suggested he wouldn’t endorse it. Even after such an operation, I might still lack the strength to return to dancing as a third surgery would cause even more atrophy. He explained that I would still continue to make progress until the one-year mark and advised me to carry on with my exercises, but cautioned that I probably wouldn’t regain enough strength to return to Scottish highland dancing.

I’m now almost 11 months post-op and it’s hard to say if I’ve made any improvements in the past three months. My single-leg heel raise still gets stuck about halfway up and I can’t control my landings when I jump on my left foot, so my heel slams into the ground every time. My calf is still noticeably atrophied and I still walk with a limp sometimes, especially in the mornings, following more strenuous exercise, and when I wear shoes that offer little heel support.

At the beginning of September, I relocated to Michigan to attend Alma College, where Scottish highland dancing is offered as a class. I’d be lying if I said I came to Alma for any other reason than dance, so it’s frustrating to continue to be sidelined, not knowing when or if I can return to my sport. It's so hard to cope with the potential loss of something that’s been a part of my self-identity since I was three years old.

I’m visiting my doctor next time I'm home. I’m hoping he’ll be able to give me some more concrete answers at this time, as I’ll be closing in on my one-year anniversary. Until then, I’ll be continuing with my regularly scheduled exercises and hoping that this is just a strangely prolonged recovery… Cheers.

"I really don't know."

Last Thursday I visited my doctor for an 8-month checkup. I thought it was going to be a short, routine visit, but it turned into an all-day event. I spoke to my doctor (and his accompanying fellow) about my minor jogging injury from the previous week and expressed my concerns over my continued pain and lack of strength. Though my doctor was not terribly concerned over the injury or persistent soreness, he was troubled by the appearance of my atrophied calf and the resulting absence of power. He sent me for an MRI of both my lower legs to see what was going on.

mikhaila_markham_mri_2

Four hours and an MRI later, I was back in my doctor’s office waiting for results. He examined the MRI images and explained that he was looking for fatty infiltration into the muscle, atrophy of the calf muscle, and hypertrophy of the Flexor Hallucis Longus (FHL). Fatty tissue growing into the muscle is irreversible and detrimental to muscle recovery, so it was very fortunate that no evidence of that was found in my MRI. Unsurprisingly, the medial head of the gastrocnemius muscle was found to be markedly atrophied.

This made my doctor question what kinds of exercises I've been doing to strengthen my calf. After listing all my exercises (including heel raises, toe walking, jogging, etc.) my doctor told me I was doing precisely what he would suggest. So if I am doing everything I can with a healthy (albeit small) muscle, why is my calf still so atrophied? With all the jogging and jumping I’ve been doing, I would expect to see some greater results.

My doctor explained that while I still have healthy muscle, it’s hard to know what the potential to gain momentum is now that I’m lagging behind at this late stage. This news has been pretty devastating. I feel like the one person who is supposed to know exactly what’s going on has absolutely no idea. It's never good to hear the words "I really don't know," from someone you trust and expect to have answers.

My doctor and his fellow hope that my Achilles and calf simply require a longer recovery time, given that my calf was atrophied even before surgery. However, he also hypothesized that my tendon was not at an optimal resting tension for so long prior to my second surgery that perhaps, despite his surgical efforts, the muscle won’t regenerate.

It seems to me that my doctor is anticipating the latter. During my appointment, he said he was very sad about my lack of power and even apologized--twice. He also mentioned a brace with a hinge and spring that could be inserted into the bottom of my shoe to better propel me during running. These remarks don’t exactly embody confidence.

In the end, my doctor suggested “sitting tight” and waiting to see how my strength is in November at the one-year mark. I was instructed to continue my regular exercises and, if I still lack power at that time, I will have to decide whether or not this is something I want to live with.

If it isn’t, my doctor said I may need to consider another surgery. This is where the FHL comes into play, as my doctor mentioned a procedure that would remove that tendon from its natural location and use it instead to bolster my Achilles. This is not a good option for dancers as it limits the use of the big toe, hindering the point. I don’t even want to consider it.

These latest developments have brought me back to my past concern over the resting tension of my new Achilles. Though my therapist informed me that there is no “normal” resting tension, she also commented that the tension in my good leg is so extreme, it’s bizarre. Maybe a lifetime of Scottish highland dancing contributed to this unusual tension, and perhaps it’s even the reason I ruptured my Achilles in the first place, but if that’s my “normal,” I feel that the surgical side should more closely match. It does not.

I'm not trying to pretend to be a doctor, but I’ve been reading some studies that all attribute optimal resting tension as the key to a successful Achilles tendon repair. My doctor doesn’t seem particularly concerned about this issue, but recent events have left me wanting a second opinion.

While I’m still working hard and continue to look for improvements, I admittedly have very little confidence that this is working. Hopefully everything will work out and this extra long, ranting blog post will just seem silly someday, but this is how I feel right now and I think it’s important to document.

8 Months / First Therapy Follow-Up

Last Thursday I went back to therapy for the first time since spring. I’ve been concerned that I’m not on track to achieve a single-leg heel raise by mid-August and wanted a professional opinion. As part of her evaluation, my therapist measured my right and left heel raises and noted that my good side lifts 15 centimeters off the ground. On my left side, however, my heel raise only measures 7.5. While I am hoping to increase this height over the next few weeks, I don’t know if I’ll be able to gain another 7.5 centimeters by the 9-month deadline.

My therapist did notice some growth in my calf muscle, which has expanded from the size of a raisin to a slightly larger raisin. However, she also said my left calf will probably never look as developed as my right.

Last Sunday I had a bit of a scare during my morning jog. I was just starting my second mile when my right foot caught the edge of an uneven sidewalk. I caught myself on my left foot, avoiding a fall, but managed to hurt my Achilles in the process. I felt a sharp pain and immediately sat down to assess the damage. After a few plantar and dorsiflexion movements I got up and made my way home to ice and elevate. It looked a little bruised and swollen the following few days and was painful to walk on, but these issues have improved over the course of the week. I took a week to rest until my pain level returned to normal and was able to go for a short jog yesterday morning for the first time since. Back to the grind!

My next doctor appointment is July 23, so you’ll hear from me again very soon!

Somewhere Between 6-7 Months

I have yet to make good on my resolution to update this blog once a week. Almost three weeks ago I lost my pet, Katmandu, who was my best friend for almost 16 years. His passing combined with my recent start at a dissatisfying job and the painfully slow pace of this entire recovery has left me extremely uninspired. However, in the past few weeks I’ve noticed a few small changes in my development that I feel are significant enough to document.

katmandu_recovery_mikhaila_markham

The first change relates to the still-unattainable single-leg heel raise. A few months ago I described my attempts at this exercise as “barely hiccuping off the ground,” but now I am able to raise up slightly and hold the position. This small movement still requires an excessive amount of effort (my calf feels like it’s about to explode after about five seconds), but it is a small achievement. I’ve been practicing this movement at my new job, which requires a horrific amount of standing idly in one place, so hopefully improvement in this area will continue more steadily.

Also, last week I noticed some improvement in my toe-walking. While before my heel would dip down significantly during my stride, I can now walk on my toes without much heel drop. However, the height of my heel is only about half of what it should be. This development is still pretty inconsistent, but because I also practice toe-walking during my shifts at work, I’m sure I’ll continue to see growth here as well. In the meantime, my coworkers can continue to speculate why the new girl keeps pacing with such concentration...

Though my therapist asked me to check in with her sometime in May, I’ve decided to hold off on any reevaluations for at least a few more weeks. I’m still unable to competently perform many of the exercises she gave me initially, so I feel that a visit at this point is unnecessary.

Having heard from a few readers who are at different stages of similar recoveries, I know there is a need for recovery-related content like this site. I want to make sure this blog is as thorough as possible, but I haven’t been doing a good job of that lately. I will try to update this blog more frequently, but also feel free to comment on this blog with any questions. Obviously, I can’t offer any medical advice, but I’m happy to share my own experiences!

Weird Feet

I hadn’t really noticed this before, but there is a pretty defined lump on the back of my heel where the cadaver bone block connects to my native heel bone.

For clarity, I traced an image of my heels to better display the difference in shape and size.

For clarity, I traced an image of my heels to better display the difference in shape and size.

My doctor performed a very thorough examination of my tendon at my last appointment. This was due to a concern of mine (and my therapist's) that a small section of my new Achilles tendon felt a bit concave. My doctor pressed on the area and was initially concerned himself, but in the end determined that the indentation was merely a result of scar tissue. After a major surgery like this, new bumps and dimples are to be expected.

So my leg may be a little lumpy and scarred, but it seems to be performing much better as of this past week! I was able to jog 2.5-3 miles three days this week without severe heel or Achilles pain. I wouldn't say I'm pain-free just yet, but I'm definitely feeling better! I am still embarrassingly slow so I won’t mention how long these jogs actually lasted, but I was happy just to get back out there on the road after a much-needed two weeks off.

Scar at 5.5 months post-op

Scar at 5.5 months post-op