Cast-rophobia - My cast didn’t make it to 6 weeks post-op and died a horrible death.

Cast-rophobia (cast anxiety) was very real (to me anyways) . I don’t know what caused it or maybe it was just the power of suggestion. (Stop reading if I’m going to jinx any cast worry on you!). I generally have a high tolerance for pain and uncomfortability, but I never experienced anything like this before.

We were posting in another thread comparing time lines about how long our casts would be on. Someone mentioned "castrophobia" and I didn’t think anything of it because my first 5 weeks in a splint/cast were uneventful. However the 2nd and last cast was put on a little tighter, but I thought it’d loosen a bit as my leg atrophied more and the compress underneath the fiberglass would "break in" like in the first cast.

At this point, I believe the catalyst for the behavior was when I rode the stationary bike last weekend. I’m thinking the activity "woke" my foot up. Now, subconsciously, I’m wanting move my foot around, rotate my ankle, crack / flex the toes, scratch - the usual things you do with your foot that you take for granted. I’m not a jittery person (like those types that do the nervous leg shaking), so this comes as a surprise to me.

I’ve been unusually busy, work stressed and somewhat sleep deprived this week which made the symptoms worse.

Oh the symptoms - where do I start… I think the feeling of inescapable confinement was the worse. My ATR’d foot also felt hot, stuffy and started to itch inside the cast. No amount of ice packs would make it go away. This lead to restlessness and irritability - you can ask my wife… I started feeling this on Tuesday night 8/24, so I decided to move my cast removal appointment on 8/31 up to Thursday (8/26 soonest appointment) knowing I would be demanding for my cast to be removed early. The symptoms got worse on Wednesday night. I tried a lot of things to get my mind off the uncomfortableness - went to the grocery store, bank and gas station at midnight, chewed gum. I was hoping to tire myself out so that I could crash quickly, but when I got home the anxiety got worse and I couldn’t sleep. 12 hours to the appointment seemed like an eternity. I reckon some Xanax or left over pain pills might have helped but I needed to be awake and alert for the next day.

As a lot of you guys stated here, I own my leg and it’s well being. This reminder gave me the push to do the needful. Mr. cast didn’t make it past 2 a.m. The Dremel tool would have made too much noise that time of night so off it came with tin snips and into the trash in two pieces. I slept like a baby.

Woke up rested, put my boot on NWB, got to work, gave a presentation to my V.P. and went to the Dr’s office.

The Aftermath: I go into the Dr’s office, and told the medical aid what happened and why. She was not happy and gave me the evil stink eye. They put me on a patient bed, leg raised on a pillow, boot off waiting for the Dr. to chew me out. Might I add, the amount of hard, dry, flaking skin is incredible. I need to grab a pumice stone when I get home tonight and start grinding away… The Dr. comes by, and I give him my explanation. He checks my leg for healing and asks about what kind of pain I’m in and I say "none, my leg feels great other than the episode". He says he’s seen crazier and worse things and totally understood my reasons. I ask a few more questions about PT, washing the wound, weight bearing and my next appointment.

What next: NWB boot for 5 days, then WB and PT. But I’m already PWB/FWB much sooner than that. I come back and see the same Dr. in three weeks.

Back to work, I can scratch and shower, life is good.

4 weeks post op.

Post Op Status:
2 weeks splint - done
2 weeks cast 20 deg plantar flexion - done
2 weeks cast Neutral/0 deg - in progress

I got my 1st cast off today and was able to really move the foot around a bit. I was asked to really dorsi-flex the ankle position so they could put me in a neutral position cast. I did so and took the 10-15 minutes to massage, stretch, wriggle, rub, repeat on the leg. It was nice to get some sensation back, but stretching the tendon and calf was a lot tougher than I ever imagined. The swelling had gone down so much more than the last visit so I felt better about the tingles - nerve damage was a concern for me, but I was told that was normal due to swelling and lack of sensation in the cast.

My ROM was pretty good (not sure how scientific this is),but in a sitting position I put both feet together toes pointed forward and they were equal. Pulled both toes backwards towards the my body, and the ATR’d foot was about 1-2 inches less than the good one. There’s just no strength behind it and now locked in neutral…

When it came time for the PA to see me, I was not successful in convincing him into putting me into my boot (NWB) instead of the cast. Apparently they did this for two people last week who pleaded and begged, got their way, and ended up falling (for whatever reason) and re-ruptured. Of course, I could have absolutely demanded it, but by the way my stretching went and the two "cases" that went wrong I opted to just wait it out and follow their program.

So I’ve got 13 more days ( I tried to up my appt.) in this cast and again I hope it loosens up a bit so I can do more flexing in there. Then it’s on to rehab.

The scar still looks like @$$, but overall I think I’m doing well.

Achilles Recovery - 2 weeks post op.

I went to the Ortho for my 2 week follow-up. They cut my splint off and the Physician's Assistant visually checked it out and said all was okay. The incision looks like it's healing pretty well, but I didn't get a chance to take a picture of the nasty scar. To my surprise, they didn’t do another Thompson test nor did they try to flex anything.

When the splint was removed, all the blood came rushing down and the parts of my foot that were splinted swelled up like the Goodyear blimp. Those parts of my foot also felt tingly as if they were asleep. There just wasn't much sensation due to the swelling (I think). I also didn’t get a chance to massage the foot as they were about to pull the stitches and PUT ME IN A CAST! (I was expecting a walking boot, because I'm really not feeling any pain. I thought I'd be ready for some partial weight bearing rehab, but that wasn't to be).

So my protocol is:
2 weeks in a splint, toes point slightly down. (completed post op)
2 weeks in a cast, same toe position (in progress)
2 weeks in a new cast, foot in neutral/perpendicular position. (which will stretch the tendon)
After that, walking boot and rehab.
And I’m to keep my foot elevated a lot more than I’m currently doing.

I think the cast is probably for the best for me, I’d be to aggressive with a boot (taking it off and stuff) and end up falling and pulling something unnecessarily.

On a crappy note - I can now see 1 month's worth of atrophy. My dominant right thigh is slightly thinner than my left. At least I can notice it. I'm going to be digging for some exercises.

Here's a picture of my current cast, I thought long and hard about hot pink, but people already stare way too much with the prosthetic Randy loaned me.