Week 7 Non surgical with Vacoped boot. -30 to 0 and flat sole today.
After what seems no time at all, I am now at 7 weeks from the ATR accident.
Today I have had my boot adjusted to go from -30 up to 0 degrees, and had the flat sole fitted.
So at or near a correct walking position.
Luckily I took my crutches with me, as the nurse suggested I may need them for a day or so following this tweak.
She wasn’t kidding. It felt very odd at first, and pulled quite heavily when I got to the previous -15 degrees point.
I’ve not yet pushed it all the way to 0, but can get quite close when pushing on the adjuster by hand to manipulate my foot.
It will be different walking as the pressure is now onto my heel instead of forefoot with the previous position and angled sole.
After the relative comfort and security yesterday, I feel soft and pathetic once more… lol.
This was the same when I went from -30 degrees fixed to -15 to -30 movement a couple of weeks ago, and I soon got over that once I could reach the end of travel in the boot.
Hopefully it will only be a couple of days at most to get to the same point now, before the true milestone 14 days from now when the boot is off.
This injury is always 2 steps back and 3 forwards at every key point of rehab to recovery.
It tests the will and patience of sufferers and especially there loved ones, but we will all get through it eventually.
Slow and steady (relatively to normal life speaking) deffinately wins the race with and ATR
Great progress Adam!
I laugh, because everytime I take a step forward, I seem to go even slower. I could motor around pretty good on 2 crutches. When I first went to PWB, I slowed down a whole bunch. I slowly got my walking speed and distance back up, just in time to remove a wedge and slow down again. Then I dropped the crutches, went to FWB, and slowed down yet again. Finally, I was walking pretty good in the boot, and went to 2 shoes (with a cane). I think I was going slower than ever- and still move very deliberately and cautiously.
The key - I think - is to break this down into as many discrete (small) steps as possible, getting comfortable (but not TOO comfortable) with each transition before moving onto the next.
Ryan, I think you’ve neatly summarized what almost all of us experienced — good job! Personally, I found the liberation of moving to FWB (and being able to carry stuff around in my hands) was so huge I didn’t mind a slight loss of walking speed. I also felt way less likely to do a pratfall FWB than I was on crutches.
Adam, your progression makes me nervous, because I don’t think it’s a great idea to combine a new stretch with FWB, because that makes the stress/stretch a “double whammy”, IMHO. A number of patients have changed ankle angle at bedtime, with their boot holding their ankle flexed all night, NWB, before they start standing and walking on it. Most of them have avoided serious discomfort or pain. That approach makes sense to me, though there are obviously many other important variables — like how soon post-whatever the angle is changed, how big the change, whether surgery shortened the AT, etc., etc.
In addition to separating the stretch and the FWB “loading”, I favor a “Goldilocks” approach to the size and timing of angle changes: If it really hurts to get to the new angle, maybe it’s too soon. If it really feels good to get to the new angle, maybe it’s too late. Somewhere in-between is probably “Just Right”. (All based on logic and judgment and guesswork, of course!)
Also, I love the idea of a hinge-ing boot as a transition from the boot to 2 shoes, but I’m not convinced that it’s helpful in the earlier stages. The few published studies I’ve seen that introduced the hinge early on in a group of patients, did NOT demonstrate impressive clinical results, as I recall — e.g., NOT as good as the UWO study, which used fixed AirCast boots, first with 2cm heel wedges, then with none (@6wks), then straight to 2 shoes (”weaning” @8wks). I think Vacoped was involved in one of those studies, which I would have hoped would produce superior results, but didn’t, as I recall.
Hi Norm,
Thanks for your detailed reply.
At the moment as I type I can and am every 30 mins or so push my foot to the 0 position in the boot. It is relatively easy to do now, with a slight tightness in the leg.
Yesterday I couldn’t get it beyond -10, so I guess it is stretching.
I must admit I was a little sceptical of the 2 step change in boot angle ‘allowance’, when there is so much adjustment on the thing.
Seems very fast from -30 and no movement through to flat and 0 degrees.
Today I’ve been walking around the kitchen without sticks. I can push the foot to around -5 with my leg straight, but can’t go any further without a fair bit of discomfort. I certainly can’t go near the flat part of the sole and put my bad foot down ‘properly’ as I take a step. I would say now I am walking on the heel section of the boot and bringing my good leg in line with it before taking another step.
I wouldn’t feel anything like confident trying to walk through and over a step on my bad foot yet, but I was also like this when it went to -15 from -30. That took 3 or 4 days before I went over on a full step, and I’m expecting this to take a bit longer.
However, it is a lot better than yesterday and feels to be easing up all the time.
One thing to bear in mind, is that I am not pushing myself into a huge pain barrier with this. I’m taking it to where I feel comfortable, which is still a fair stretch, just not that painful.
The pulling is weird. Sometime it is down the right hand side of my AT and other times it feels like a tight sock pulling in a ring around my leg.
I am guessing this is both the AT stretching and the calf muscle. Feels odd though to say I haven’t had any surgery.
As for too much too soon, tbh I got fed up reading all the different studies and protocolls as the are all so different. I’ve settled on what I am getting as my private consultant agrees with what the NHS is doing, and she is quite well thought of apparently.
I’ll continue to go by feel and should the worst happen and it breaks again, such is life, but I am not rushing anything or pushing it too far beyond mild discomfort.
I’ll get better eventually, that’s the main thing. :o)
Another day and maybe another story.
Took the boot off this morning to change the liner.
Had a quick look at the tendon area, and there is a 2 inch long flat spot in the tendon area.
I don’t want to poke and prod where I shouldn’t, but I could feel a hardish bit down my leg, although nowhere near as pronounced as my good tendon.
Seems something is there although maybe not al that should be. Also seems to be a slightly harder area in my calf, which again doesn’t sound right.
No real pain as such when touched, not like it was when I first ruptered and it was incredibly sore to touch.
Am now trying to get through to the hospital phone to book in for a proffesional opinion, but i don’t have a good feeling about it.
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