WK5…got the boot, but…..

Sooo, I got the boot, it’s a ROM walker too, yaaaaay :)

But my ROM was pretty limited and the boot was set based on my immediate capabilities out of the cast, now that I am home I have a bit more plantar flexions (toes pulled toward shin) so I am limited by the walker now, but out the boot things are limbering well and airing on the side of caution whilst walking around is all good for me.

By the way, I walk like I am a sword fencer now, slapping my ROM boot in front of me and have the trailing good leg play catch up lol :) 

I wish I could hold my foot neutral though, because I was told I could sleep with the boot off (great!!) but all the velcro tearing as I put it on for a bio break is bound to wake up the missus, who really dislikes being woken once asleep…. having a neutral foot position would of allowed me to use a bed brace…….open to suggestions though.

I was not prepared when I saw how swollen around the heel was still not looking great… I thought it’d be looking more regular by now.

Being able to choose if I should have a bath or get a boot cover and have a shower… little glimpses of freedom coming back, makes me feel much better about the situation.

16 Comments so far

  1. hillie on July 3rd, 2012

    Everybody’s getting boots it seems - good news.

    I’ve never had the ROM boot that you describe but you are now obviously at a milestone, and very happy to be making significant progress.

    By the way, plantar flexion is when you move your foot downwards, toward the floor, like a ballet dancer does when they are en pointe, (per Wiki) and at your stage of the healing process.. Dorsiflexion, as I understand it, is when you move your foot up (past 0º) toward your leg.

    Why do you think that you need to hold your foot neutral for sleeping without the boot? Or have I misunderstood your logic? I can only speak for myself (although standard protocol at my hospital), but at week 4, when my boot was at 15º PF, I was bootless in bed. Very nervous at first, with a pillow between me and my OH’s legs, and I had to put boot on when getting out of bed.

  2. andrew1971 on July 3rd, 2012

    http://www.ossur.co.uk/Products/foot/walkers/rom_walker

    I dont want to sleep with it on, but I dont want to make a sound putting it on so that I can walk safely to the toilet for a midnight pee.

    and If I was at 0 degrees, I could wear one of these two lightweight options to bed, thus enabling a comfortable sleep and a safe (yet silent) walk to the toilet.

  3. andrew1971 on July 3rd, 2012
  4. hillie on July 3rd, 2012

    The simple fact, Andrew, is that you are not at 0º yet. And, again, what is the big deal with these night splints? Perhaps if any other readers here have tried them at this stage they could post their comments.

    You know that there is a reason for this and you have to be patient for a little longer. Yes, the velcro makes a noise, and yes, it may wake your wife, but it isn’t going to be happening for long - and you (and your wife) do want a good recovery.

    I was once told that if my crutch skills were good, and I had a safe route to the loo, that I could ’simply’ go barefoot (ATR foot off the ground, but able to touch) supported by the crutches. I did it once or twice and it was ok, but other than that I used my boot, complete with Velcro. It was the safer option and I wasn’t about to jeopardise this ridiculously long rehab cycle that we have to go through. Unless you have to, try not to drink much during the hour or two before you go to bed, in an effort not to go during the night - I appreciate that for whatever reason this may just not be possible.

  5. kimjax on July 3rd, 2012

    Hi Andrew - I feel your pain! I also hate to sleep in the boot, and really didn’t sleep much for the first 7 weeks. I’m doing a little better this week (8) as I’m sleeping in my big black boot with the soft sides vs. my hard Vaco boot that I like best for walking.

    I bought one of those night splints (cheap on ebay) and it was more uncomfortable than the boot - no kidding! It catches you mid-calf and rubs funny on my scar. You are not supposed to walk in them as they offer no support - they’re very lightweight. I had really high hopes for it - but very disappointed. Sooo… you can try one yourself for $20 or so - but you’ll still have to put your boot on to go to the bathroom. I drink like crazy until 7pm and then stop so I don’t have to get up.

    Most nights, I rip the boot off by 4am and enjoy 2 hours until wake up with a barefoot. It doesn’t hurt anything and I’m able to stretch back to zero in the boot. Hang in there - only a few more weeks and the boot will feel more comfortable as your leg gets stronger and less sensitive.

    I took a benadryl one night and it knocked me out cold despite the boot. :)

  6. normofthenorth on July 4th, 2012

    As hillie said, those splints are NOT safe for walking, in the middle of the night or any other time. If you slipped and put weight on it, it wouldn’t save your AT, while the boot probably would.

    If you’re cleared for FWB in the boot, there’s no reason to walk like a fencer, leading with the ATR foot. The boot is designed to let you stride right over it, shifting the force a normal calf-and-AT exert, via the boot, to the front of your shin. Plant the heel of the boot, then push your boot-side knee forward while swinging the other (uninjured) foot ahead. Keep your boot toe pointed straight ahead, or at least as straight ahead as your other foot is, normally. “These boots are made for walkin’!”

    It’s important that your other (uninjured) foot be shod in something that has as much elevation to it as your boot does, so your hips are straight when you stand and walk. Multiple shoes, thick boots, footbeds, cast shoe, custom-made modification, whatever, but DO it. Otherwise you will risk injury and likely teach your body a new — and BAD — way to walk, which will be hard to UNlearn later.

  7. normofthenorth on July 4th, 2012

    (Really as Kimjax said. . .)

  8. hillie on July 4th, 2012

    Hi Andrew

    Getting the balance between good leg and bad leg really is a big deal. I wore a hiking shoe on my good foot when wearing my boot on the baddie, and still I had issues with my good-side knee and AT. Too late I discovered a ‘booster’ product: http://www.vacocast.com/storage/pdfs/VACOcast_accessories.pdf which you might consider. Or just get innovative. It seems that some ladies use a wedge shoe but you might not want to do that… A step too far?

  9. andrew1971 on July 4th, 2012

    Good advice all thanks for the replies - I have chunky soled trainers and this ROM walker seems to offer an identical height to my normal trainers - that was lucky…. before I knew which boot I was going to have I had already eyed up the limb height equaliser on the vacocast accessories pdf…. just in case.

    When I am PWB, should the range of movement limiters be comfortably within my current range of movement without the boot on, or should I be looking to feel some stretching when walking in the boot?

    Reason I ask is that now I am out of the fixed cast for over a day now my Range Of Movement is considerably more than my boot allows and I am wandering if I should go get it adjusted?

  10. andrew1971 on July 4th, 2012

    One final question at this stage of my recovery - I am gently massaging the ankle and it’s like maniuplating putty where the swelling remains (much to my 13yr olds amusement) I have read that it takes a long time for that swelling to diappear completely, will compression socks help in the reduction of swelling?

  11. ali on July 4th, 2012

    Hi, I used compression sock or a flight sock. I definately found it helpful.

  12. kimjax on July 4th, 2012

    Hey Andrew,
    I stood and walked a lot yesterday (all day) and had a big fat ankle last night (I’m at 9 weeks today) From what I hear, swelling continues on for months. At my stage, I only get a lot of swelling when I over do it and it was back to normal little swelling this morning. Compression socks help a lot from what I’ve read - just do a search on the blog and you’ll find some good recommendations concerning them. I’m not sure when you can start using them.

    As far as the ROM on your boot: you need to ask your doctor - mine won’t allow more than zero to 10 degrees right now - which is pretty conservative from what I’ve read. I have fairly limited DF, however, and my AT is pretty tight as I had a lot of it clipped off.

    I am still using the big Vaco sole and fixed hinge for big walks, and using the boot with the hinge open only for short walks as it really irritates my AT right now. I try to do longer each day. I love the stationary bike as I can really ride it hard with no ill effects - as a matter of fact, I feel much better once the blood gets pumping in the leg! I’ve only skipped PT once, and I was miserable the rest of the night. It really helps to keep the leg working.

  13. ali on July 4th, 2012

    BTW the night splint is designed for plantar fasciitis, (I have one of these for the ‘other’ foot - you have to clip it in to place so it probably makes as much noise). It does its job for PF but its a different problem. Agree with the others, your boot is designed for purpose, hang in there with it :)

  14. hillie on July 4th, 2012

    Hi Andrew

    Many of us are on aggressive/accelerated protocols similar to UWO, and we typically have a 2 week spell between adjustments. 1 day might be considered ambitious unless perhaps boot was set up incorrectly.

    I obviously don’t know if your physio or doctor explained about the reasons for the controlled changes, or if you have been given that (vital in my view) written protocol/timeline which helps to remove much of the uncertainty. As Kim suggests, talk to your doctor. Adjustment this soon doesn’t seem a great idea, but who knows…

  15. andrew1971 on July 4th, 2012

    Thanks again all for taking an interest in my blog, your advice is invaluable and encouragement really helps.

    My feeling is that after 5 wks in a cast the stiffness I had limited the range of movement I had immediately out the cast. As my foot has loosened up overnight and during todays exercises I find I am much closer to 0 degrees (stood upright) than my boot will allow.

    I am gong to see if I can get an appt at the otho center for their opinion, this is new to me but I really do believe my boot is set at least 1 notch short of where it could be without stressing my tendon.

    The ‘only’ thing I got explained to me was 2wks between apointments now for ROM review/adjustments for the next 6 weeks.

    I don’t have a written protocol but that does not bother me too much (although I am keen to find out when I get invited to PT sessions), I feel confident we’re working to a reasonably aggressive schedule, my only immediate concern is that I do think I am starting from the wrong point of RoM setting due to ‘out of cast’ stiffness during the set-up.

    I plan to keep doing the NWB movement exercises in the interim because it’s just great to have some freedom.

    Thanks again for the comments, much appreciated.

  16. normofthenorth on July 6th, 2012

    That seems sensible to me, Andrew (FWIW).

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