*WK 4-5: Things are stabilizing… (Jul 1st - 15th, 2016)
July 15, 2016 by agnesatr
These past 2 weeks have been pretty good. In week 2 and 3 I got used to crutches and iWalk2.0. I also gained confidence in going out on both of them.
Week 4 started with the 4th of July weekend - Independence weekend in USA. I decided not to hold back that weekend. I mowed part of our lawn wearing iWalk2.0, ran some errands with my hubby and brother (I will need drivers for a while), hung out few times with friends from out of town, and went to a 4th of July party. The reason for writing about all of these is that if you are going through ATR and are in early weeks - things do get easier pretty quickly. I am still in the beginning of my treatment, but life is already becoming more normal.
MOWING LAWN ON IWALK 2.0 
I was still non weight bearing (NWB), however I started applying pressure on my injured hill while wearing the boot. I was still wearing the boot at all times even in the shower (using a bag over the boot). My boot was set at about 25 degrees plantar flexion. I also noticed that my leg did not swell as quickly as in previous weeks. I could keep it down much longer during the day. On busy days when I did not get a chance to elevate much, it swelled quite a bit, but some icing and elevation in the evenings helped with that. Another thing is the bruising I have on my heel. It is not from the impact of the injury, but it’s a blood that dripped from the rupture site to the heel. It is definitely getting smaller.
4 AND 6 WEEK HEEL COMPARISON
I was told to do range of motion (ROM) exercises for 5 minutes every hour. This has been the best part of the last 2 weeks. I did these exercises about 8-9 times a day. By the end of week 5, while doing ROM exercises and holding my tendon I can feel it being pulled and its thickness feels closer to the healthy one. Hubby suggested to remove sock while doing ROM exercises and it does makes it more enjoyable for the foot. The leg is cooked up in the boot for 24 hrs, so any freedom feels good. I started feeling tingly in my toes and on top of my foot in the last couple of weeks. I am not sure if that’s because the foot is in the boot for such extended period of time. Massaging with some lotion helps with that, however.
ROM EXERCISES
I am continuing with my NWB workouts almost daily, which is helping me stay in the same shape as before the injury. It definitely lifts my spirit and gives me more energy for everything else during the day. That’s something I would recommend to everyone. I just make sure to tighten my boot more, so that my injured foot does not move as I lift it. I think I got most of the strengthening exercises down, but having issues bringing my heart rate up with only one leg to use. Some yoga balance exercises help with that. I also have been attempting one legged burpees and one legged jumps and that gets me out of breath quickly, but I cannot do many yet with one leg only. Will be working on these to break down some sweat.
Today I had my 5 week doctor’s check up and it went great! I am in a week 4 in my protocol. The doctor liked how my tendon feels and looks. He was really happy with the healing progress. There is not gap. Thompson Test yielded some movement in my foot, but I was told that this test will be more conclusive at the 3 month mark. I was told ultrasound or MRI will not show much at this point as collagen does not show up that well on these. My boot was moved to neutral position and 1 wedge was added (equivalent to 10 degrees). I was moved to partial weight bearing (PWB) in a boot (yay!!!). I am supposed to start with 45lbs of pressure while using crutches. In 2 weeks I am supposed to remove the wedge, moving me into neutral, and start weight bearing as tolerated. I am supposed to continue with my ROM exercises. I was cleared to do stationary biking while wearing a boot as well. I will update in couple of weeks on my progress of PWB! My right calf, on the other hand, is definitely missing some muscles!
WEEK 5 CALF ATROPHY
For everyone just starting out, I can say from my weeks 4 and 5 that it did get easier for sure. I feel as a lot of it is in the mind. Once you get used to the new situation and have systems in place, the rest sort of happens and time passed by faster. So, be patient and happy healing!
HERE IS MY VLOG FROM WEEK 4 AND 5:
You are progressing well Agnes but mowing the lawn with an electric mower and an I-walk takes some effort. Well done. Your progression to FWB will come easy enough once you find that PWB is pretty easy.
Hi Agnes: Thanks for your blog and details about your injury and your progress. My wife suffered a total achilles tendon rupture in her left leg this past saturday playing tennis with her girl friends. I was at home and her friends had taken her to the ER. I was informed and rushed to be by her side. She was placed in a temp plaster cast similar to yours and was fitted with crutches. Over the weekend we were searching the internet and learning all about this.On Monday of this week we met with an ortho doc whom we have seen before for various issues and she recommended surgery but also gave us the option of treating the rupture with a cast or brace. If we chose the nonsurgical route she recommended that the casting route would be better and would maintain total immobilization. Did your doctors mention anything about cast treatment vs. the CAM boot? Anyway, today we met with a second ortho who is a friend of a friend and he recommended surgery followed by cast and then boot immobilization.
Anyway, tomorrow we have another appointment with our first doc….and we have to make a decision. My wife is leaning towards going the nonsurgical route. We also ordered a knee scooter so that she could get around the house and eventually when she returns to work (she is on medical leave all this week). How are your managing going to work and commuting? She is pretty miserable with this sudden injury…given it is summer and everything…but your blog has helped reassure her that things will be better. Thanks! we will keep you posted on what happens tomorrow.
Thank you Stuart. I am loving PWB and can see that FWB should not be too bad in week and a half. I am like a kid all happy to use both legs.
I am trying to use that iWalk for most things to keep my life as normal as possible. Hope both of your tendons are still as strong as ever!
Tommy, really sorry about your wife’s rupture. Yes, the first 2-3 weeks seem to be the worst and after that you get used to things, so both of you hang in there for now.
To answer your questions:
- my doctor placed me in the boot immediately without mentioning cast, so we did not have this conversation. Incidentally, I was asking someone about casting today and their doctor mentioned to them that casting is used sometimes to ensure total immobilization and prevention of patients removing the boot and compromising recovery at an early stage. From my experience and from my protocol, for the first 2 weeks after deciding on a doctor (week 2 and week 3 post rupture) I was not to take boot off all and be non weight bearing (NWB). It would not matter if I was in a cast or a boot in these first 2 weeks of protocol. Week 3 of the protocol (week 4th post rupture) I was told to start range of motion (ROM) movements with my injured foot, so the boot was needed at that point. When you see your doctor, do talk about protocol. Early ROM and early weight bearing in boot is encouraged for recovery.
If you choose the surgical route, I think cast is pretty customary after the operation. For non-surgical route, I have seen both. Long-term casting, however, is not recommended according to the newer studies.
- As far as getting around, ask your doctor tomorrow if your wife can drive (if you have auto transmission) since it’d her left leg that is ruptured. Unfortunately for me it is the right leg, so I cannot drive anywhere myself, I always need drivers. She will get used to the crutches. People outside are nice to open doors for you and move out of the way when they see you on crutches. The handicapped buttons besides doors help too. I use iWalk for everything. Stairs are easy with it. I asked the first doc I saw to write a prescription for the iWalk and will try to file it through my insurance. Also, the second doctor gave me prescription for a handicapped permit. If your wife can drive, that could be helpful to have. If your wife goes back to work next week, then elevation will be a key. It is awkward, but I was putting my leg on a desk while working on a computer in the initial weeks. So mobility with work is definitely something to plan.
Hang in there and ask your doctor tomorrow as many questions as you can think of before making your decision.
Also, check out Evan’s blog. He is over a year non-surgical: http://achillesblog.com/ejbvmi/ and his youtube channel: https://www.youtube.com/playlist?list=PLu1nHtWBBf8YfYz6JCH4z_vrVBF592gHI and was great help to me.
Whichever way you decide to go with, the recovery is long, but if you were active before the injury, you can still workout while NWB and be socially active. It just takes bit more planning. Good luck tomorrow!
Thanks Agnes…wow that was a lot of great information…never even thought about half of what you pointed out. I am super glad we were able to connect before yesterday morning’s appointment.
Yesterday was a very busy and somewhat exhausting day….that is why I could not update you. Our appointment was at 9:45 am this morning. This a large ortho practice…so even at that early hour in the day there were a few patients already in the waiting room. While we were waiting to be called into see the doctor, my wife spoke with a teenage lady with a temp cast who was with her mother. The teenager broken her ankle while playing softball and come to get it casted….
Anyway, we were called in and the doctor removed the temp cast splint that was placed by the ER and rewrapped by the current ortho doc when we first had our appointment on Monday with her. She examined the ankle.. Once again, we went over our options and she once again said that she would recommend surgery, but she would be happy to go the non surgical route as well if that was our preference. She said if we go the nonsurgical route that she would begin with a short leg cast for two weeks followed by CAM boot….with heel wedges….over a 8-10 week period. But either way she said that since it was only diagnosed initially with the Thompsons test, that we need to get a MRI so that she could have a base line. Anyway, she asked us to wait until her assistant was able to see if they could schedule an appointment with an imaging center for the same day. They rewrapped my wife’s foot and she hobbled on her crutches back to the waiting area.
We also briefly spoke about driving and returning to work etc. She said that as long as my wife is comfortable getting in an out of the car with crutches and NWB she was ok with it. But the doc said that it would be good if my wife rested for another week before thinking about getting back to work…. Glad that you reminded me…I asked a note for a handicap parking permit.
Luckily imaging center had an opening at 11:00 am and they were able to fit us in. We managed to get in the car and head to the imaging center were they prepped her for a the MRI of her foot. Afterwords, we were given a CD of the imaging and we headed back to the ortho docs office. Although, our doc was about to head out she was kind enough to stay back and reexamine the MRI. Following this she instructed us to come back and in 2 weeks for follow up. After this the cast technician came in and took my wife in a wheel chair to the cast room to begin the casting process. If you have not seen this process it is pretty interesting. My wife was also given to a color samples and asked to pick out a cast color. She went with purple. The cast tech instructed my wife to slip off the shoe from her good foot and to hop on to the exam table and lay on her belly. Then she began casting. First a sock like material was rolled though the toes to her knee, and then applied several roles of padding. Once this was done a white fiberglass roll was applied and she began to bend my wife’s ankle upwards…she explained that was to make sure the two edges touched….My wife grimaced with some pain. After which she folded the extra sock like material exposing her toes and like wise bending near her knee. This was followed by another two wrappings of purple casting tape. after molding the cast further the process was finished and we were ready to head home….feeling and hungry and exhausted.
Anyway, today she is slowing getting used to the life in the hard cast….she also applied for another week of leave….we will decide when is ready to go to work….. anyway thank you all your tips…they were great….Hope your healing is progressing well…
Tommy - glad to help and good to see that your wife is on her way to recovery. The beginning is the worst as one needs to get used to literally everything. But I will reiterate that it does get easier!!!
It’s nice to see you guys managed taking care of the imaging and casting the same day. Now you can mentally relax!
Every recovery is different and all bodies are very different, but in the first couple of weeks post rupture I was easily getting tired doing simple things even though I am fit and active person. That was new to me and I suspect it was my body healing at that point and letting me know to take it easy. It is definitely a good idea to relax initially and elevate the leg most of the time. My husband was wonderful help in these first weeks and that was greatly appreciated. The iWalk also gave me my independence early on.
Now I am past week 6 mark and am almost full weight bearing. I am walking in a boot with one crutch for balance only. Again, every recovery protocol is little bit different, but always discuss the next protocol steps with your doc and follow it once you agree on the progress. Good luck for the next couple of weeks until you see your doc again! Have a good relaxing weekend!
Hi Agnes :
Thanks for the wishes and your very generous tips. Yes, the last one week was pretty stressful for us…. I am glad that we were able to decide on the best course of treatment. Although stuck in a cast, my wife is also slowly getting adjusted to her new situation. She is getting better at using crutches, and feels confident on them. At the ER they did not give much crutch training. Was this your first time on crutches as well? There are also lot of good videos on you tube. After her foot was casted we were given instructions on cast care etc. Wow….let me tell you…trying to get in an out of the shower with a cast and crutches is the hardest. We wrapped several garbage bags around her leg and she managed to slowly crutch up to the bath tub and holding on to me she climbed into the tub. After the shower she called me back and I was able to assist her out of the shower. i guess you did not have this problem since you were in the boot right? BTW we also received the knee walker we rented…..she will try to use it around the house and get some independence. And may take it work.
After breakfast we sat on the couch and remised about the past week. My wife said how weird it felt to be in a cast and feel so venerable balancing on one good foot. Anyway, we were both happy that she was on the road to recovery——although it is a long one. Also what do you ware on your good foot? Do you always where a sneaker around the house? Are flip flops safe? My wife is a big flip flops person… I am worried that she may not be able to balance well…She also called her office and spoke with her boss….who said she could telework sometime next week if she wishes…and to come back to the office when she feels well enough…..that was super nice. She was also trying to figure out how and what to dress when she returns to work…. What has been your experience dressing and commuting to work in a boot.?
Anyway, to cheer her up i said that she should get a pedicure—since her toes will be exposed for a while. So after words we went out and she got a pedicure. I said that she should start using the knee walker but she insisted that she will uses crutches since it is easy to get in and out of car. Later in the evening a two of her colleagues visited her with a card and a fruit basket. That was really nice. So all in all we are slowly progressing. It will be one week for this coming saturday.
We are happy to hear that you are doing very well….best wishes and have a good weekend…. And thank you again for been so helpful and generous with your experience. It really helps my wife.
Glad to hear your wife is getting adjusted well, Tommy. Yes, it was my first time on crutches as well and there was no training for me either in ER. I just got a prescription for crutches from them and then was on my own to figure them out… Yes, youtube was very helpful then!
For the shower, your wife might want to use a shower stool and cast cover. I am using the cover over my boot till this day as well. I am not supposed to take the boot off for the shower. That gets easier with practice as well.
As far as footwear, I do wear snicker around the house as initially you need to hop some, so I found it safest to be in a soft snicker. I had one that you do not lace up, so it was also easy/fast to put on/off. As far as going out, I wore any flats, dress up or casuals, but I did not brave out flip flops, I was too scared that they might not stay on my good foot well and put me off balance. But that’s me. I was not advised by doctor on it, it’s just my own sense of security.
So nice of you to set you wife with pedicure! You definitely scored some points with that one!
Btw, for some equipment, I just uploaded what I have been using so far. You can check it out here: http://achillesblog.com/agnesatr/atr-equipment/
Good luck to your wife and you for the coming week!
Wow Agnes…you have thought about everything…amazing…we are thankful for your tips. It has been one week since my wife was casted last Wednesday. I returned to work this week and my wife started teleworking from today onwards. On Monday evening I stopped by Wal-Mart and got her a shower stool….thanks for that tip.It is now easy for her to sit and have a shower instead of trying balance on one leg. We also ordered an AquaShield waterproof cast cover. It arrived today….now no more trying wrap trash bags. So little by little thanks to you we are learning how to deal with this. My wife’s mom also came to help us out this week….with my wife’s incapacitation things are getting messy around the house…I was just thinking what it would have been if we had kids. Things could have been really stressful. My MILs presence has also taken away my wife’s boredom. We also came across this youtube channel https://www.youtube.com/channel/UCS4sSp8Zt7EhgKX-kYT1i2w/videos that has some great tips….and exercises…that you could do with one leg. So my wife is trying out some of these.
Since my wife was not keen on the kneewalker/scooter we returned it and ordered https://www.youtube.com/watch?v=lQp-nDbE864 In-Motion crutches….these can be folded and also has better ergonomics so it will come handy when she plans on returning to work next week.
She also ordered a pair of Teva sandals which has good stability and a strap around the ankle so it will not slip off her good foot (BTW Teva’s and Birkenstocks were her favorites while in college). She says she feels more normal having her toes exposed on both feet than just the one.
She needs to figure out what to where for work next week. Any suggestions would help… We also plan on going to her office this Saturday to see what things need to be set up and also do a dry run on how she will manage navigating around her office in a cast and crutches..This is going to be a weird experience for her….
Now that it has been a week she is starting to complain that her skin is itching under the cast…in the instructions we were given on cast care they said that to use a hair dryer on the cool setting. This has given some relief….but the heat this summer on the east coast is not helping.
So we are moving a long and taking one day at a time…and learning as we go on how to deal with this unexpected inconvenience…. Thanks for your support… here is a pic of her cast soon after application: http://tinyurl.com/jt8d2cw
I am really glad you guys are adjusting better and better to the new situation. Thank goodness for internet, cause doctors unfortunately do not give out all the care tips…
For work clothes, dresses and skirts are great with it being summer and they are the easiest to put on without using that bulky leg. Dress shorts are an option too, but it all depends on the dress code at the workplace. With the cast the pants might be hard, but once your wife get switched to the boot, they are possible to put on and left in the boot. I know I avoided pants at the beginning, as I was skittish about placing my leg in them.
I like your wife’s matching snicker and cast! Good for her to start working out. I recommend it to everyone as soon as they can do it. It definitely helps the rest of the body and allows to stay in the same shape. Good idea also with the weekend scoping at work.
Wishing you good luck with the new crutches and with continuation of your wife’s recovery!
I just ordered the iWalk2.0.. I hated the scooters so I hope this is a better solution. Thamks formyour blog.
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