Yesterday I had the opportunity to have my second follow up with my doc. After being in the hard cast since October 25th with my foot in it’s natural angle lying off the side of the table it was time to take that cast off and try to recast my foot into the 90 degree for 2 additional weeks. Not so much…. I felt bad because the orthopedic technician that was trying to angle my foot into 90 degrees had a difficult time because it’s almost like I didnt let her. It’s not that the there was pain associated with the method, but I did feel very uncomfortable because the tension on the achilles was so tight that it almost felt like it was going to re-tear all over again. Long story short is we attempted to get to 90 degrees but that wasn’t happening this time. My next follow up is scheduled for the 15th to get to 90 degrees from where we are at now. Hope it goes well and then the 22nd I get the boot.
One of the (~93) advantages of a boot instead of multiple casts, is that it’s easy to make multiple small angle adjustments, without even needing a “technician”. I started with 3cm of heel wedges in a simple “fixed” AirCast boot, and my protocol called for all of them to come out “cold turkey” at 6 weeks. (By then, I’d been FWB for 2 weeks, and I was walking very fast unaided.)
When I tried taking them all out at once, it felt too extreme, so I spread it out over 2 or 3 days. It’s only “technician” stuff if somebody has to mold a new cast to do what’s a really simple job for a boot. Some boots have adjustable angles (”hinged”), so the adjustment can be made without heel wedges. The big advantage is that those boots can later be set to “hinge” between neutral and plantarflexed, to make a gradual and protected transition between immobilization and “2 shoes”.
One little fillip that’s especially helpful when changing ankle angle, is to remove heel wedges at bed-time and sleep in the boot at the new angle. Even if it is a bit of a stretch, giving it ~8 hours of NWB at the new angle usually makes the transition easier — and safer, too, IMHO. (Try THAT with a cast and a technician!)