Back in the plaster room today

Hi all had my two week appointment today in the plaster room at hospital.  They put a metal heel on my cast and some more plaster making it seven heavier!!!

They said I should be able to put weight through this but not sure how yet.  I am able to walk without hopping on crutches and I ws able to get in shower with seat and put my foot down which was a treat.

I am back in another two weeks when they will cut open the front of my cast but that is all I know and I can’t imagine how cutting open the front how the rest won’t fall off???

i feel very uninformed and a bit lost as on all the blogs I have not heard of this approach, so if I am not alone I would love to hear from you.

i am in Suffolk in England under the NHs non operative

any thoughts?????

25 Comments »

  1. davidk Said,

    August 18, 2014 @ 5:10 pm

    Blondie, I’m a little confused by your post–can you clarify if you are currently placing weight on your injured foot (i.e. PWB or FWB)? Also, are you still using crutches? As to having your cast cut open in two weeks, my educated guess is that they will be removing your cast (entirely) and giving you a walking boot then. Lastly, I recommend writing down a list of questions to take with you the next time you have a doctor’s appt. Otherwise, it’s very easy to get distracted and then you forget to ask them. -David

  2. Stuart Said,

    August 18, 2014 @ 5:20 pm

    I think I can recall this happening once but cannot remember to whom. The cast would be held on with bandages I would imagine (so you can take it off to bathe) but for the life of me I cannot see any good reason to do this when the NHS will provide you with a boot. I don’t know how the NHS works but in the land of Oz we have a similiar government (taxpayer) funded system where specialists contract to the hospitals but have their own private practise as well. If the same it means the NHS would not have a standard way of treating this injury and relies on the individual doctor’s method. You can go outside the system if you can afford it. You are not locked into this one doctor. Maybe to get a second opinion it would be worth it. Going non op it is important for the best recovery to get yourself onto a more modern protocol. Maybe someone here who is nearby can assist with a recommendation.

  3. hillie Said,

    August 19, 2014 @ 10:21 am

    Blondie

    Sorry if I’ve said it before but I’m in the UK too, had a complete atr, was treated non-surgically at Exeter in Devon under the NHS. There the similarity ends! If you’ve read many of these blogs and posts you will see that Exeter’s rehab schedule is one of the quickest and most successful (as evidenced in the abstract quoted in Suddsy’s excellent achillesblog - read all his separate posts).

    I was in a fibreglass cast (blue and white, choice of colours) for 2 weeks, then into a Vaco boot for 6 and a bit more. My foot was pointed down 30º for the first 4 weeks, then the boot was adjusted to allow an increasing range of movement and promote early mobility, weaning off crutches by around 3-4 weeks. So no remaking of casts, no metal heel (!?) and, importantly a written protocol of what to expect, week by week. Oh, and a direct number for the fracture clinic if I had any concerns (as you certainly have).

    Light exercise of the injured limb started by week 3.

    At some hospitals they will tell you that ’serial casting’ is cheaper than seemingly pricey boots. However my boot was fully recyclable with all parts easy to replace and the refurbished boots put into store for the next patient.

    Maybe you’ll get the boot after week 4 but you have 2 weeks before you next return to hospital. You’re probably not terribly busy right now so do some research, copy the protocols from Suddsy’s blog and the Achillesblog homepage (mainly UWO Canada) and take these to your appointment along with the details of the Exeter specialists (listed in the abstract). The boot that I had is usually being promoted on the Achillesblog home page, but there are many others and I have no experience of them.

    Before then however, call your fracture clinic and ask them what happens next, can they send you a rehab schedule, what can you be doing yourself to maintain some flexibility (it won’t be much but it all helps, like carefully writing the alphabet with your foot). Is your foot pointed down at all?

    If you want to do better than you are expecting, you need to take the initiative - don’t be ignorant of the facts, do that research, ask those questions, take a friend, make notes while talking to your physio or doctor.

    Above all, be determined to make a good quality recovery - be one of the positive bloggers here.

    H

  4. Pegleg Said,

    August 19, 2014 @ 12:39 pm

    Blondie I too was treated via NHS up in Scotland but surgically and had a completely different experience again - also my friend had a complete rupture and was treated non surgically and was told only basic facts and left very ‘free range’!!

    Hillie I think that you were perhaps very fortunate and had one of the best NHS experiences with a stroke of luck that it was at Exeter. Like Blondie I was not given a protocol even after asking for one, I was simply given very basic suggestions of my path ahead. Saying that I did ask plenty of questions and usually got an answer of a kind although at times vague! I do think Hillie does have a very good point though, you should go back to your OS armed with facts but make sure you understand them. To an extent I took my rehab into my own hands but only once I was in the boot. The metal plate does sound rather strange - I guess to give extra strength but very antiquated, I was in a back plate with bandages for the first two weeks then put into a cast so you seem to be doing things in reverse! I agree that you should question this and make suggestions for the boot - it will be interesting to see what they have to say about that!

    What is important is that you don’t let this get you down, I remember all too well how overwhelmed I felt when others talked about protocols (although I do fully appreciate they tell us to help us in the long run which I applaud!) you must stay positive and try to get some answers and take things from there, making informed decisions. On a plus regardless of everything you will still be slowly healing and that is the main thing but it could perhaps be improved upon. Take care and be pro-active, good luck.

  5. hillie Said,

    August 19, 2014 @ 1:16 pm

    The variation in treatment quality doesn’t seem in any way connected to whether we are surgical or non-op cases. It is down to the individual doctors and the hospitals in which they work. My written rehab schedule emphasised that it was the same whether or not you’d had surgery.

    Fortunate and lucky - yes thanks, I’m happy with that, but these atr issues are improving. If you were to search on the home page under Edinburgh, you will see that in 2009 they were serial casting, now they appear to be offering the Vaco boot, as are (and I quote) hospitals in Blackburn, Leicester and elsewhere. “Other boots are available”. If Exeter, Belfast, Ontario are setting the benchmark so be it. All hospitals have limited funds, and it is how they spend them that matters. Quality counts and you get less ‘returns’ (aka re-ruptures and clots).

    Fortune and luck only play a part however. You can make yourself mobile at 3 weeks or earlier, or you can be a couch potato all day. You can use crutches for months (and I appreciate that some do just have to) or you can exercise and mobilise early on. Seek out the good physio’s if you can - the surgeon has had his turn! If you are not offered a written rehab, take one from these pages and give it to your physio or doctor - ask them why it won’t work for you.

    Got to go now, the dogs want their walk.

  6. Pegleg Said,

    August 19, 2014 @ 2:04 pm

    Yikes, I am not sure how to take that reply, I was merely trying to give a balanced answer that does not promote that ‘panicky/fearful’ feeling which many of us experience in the first few weeks of the unknown!!
    I do appreciate that there are some great new and more importantly proven protocols out there and can only hope that someday soon all hospitals etc do use these, but unfortunately we are not quite there yet and yes cost has a lot to do with it!
    Another problem is that not all of us live near other resources or options, for example my next nearest main hospital etc is 2 hrs away, not great to get to when you can’t drive or don’t live on a bus route. But as soon I could I did created my own rehab routine from reading the mentioned studies and once cleared to drive, I did get myself to private PT and that’s where I am now (and making good progress). In some situations a lot is down to personal drive and determination but the main thing is we do usually get there in the end.

  7. hillie Said,

    August 19, 2014 @ 2:53 pm

    I guess that you could take it the way that it was intended, that is just adding to what I had already posted, even trying to get across the fact that from the north to the south of the country, improvement is happening, albeit slowly. As far as funds are concerned, the whole NHS is cash-strapped, but they can largely decide how well and where they spend or waste much of their money.

  8. nosport45 Said,

    August 19, 2014 @ 6:13 pm

    Hi there, I like you went non op. In Yorkshire, being treated through NHS. I was in plaster for two weeks n this was still painful at times. I had to adjust how leg was elevated due to calf pain. It felt like I was just on the brink of getting cramp sometimes but never fully did. When standing or sitting with leg down it was worse n toes got more blue. Think it was because of swelling. When plaster came off it was still swollen and bruised. I would lay on one side then other. Changing position a lot. I made sure I was mobile as possible and wiggled toes frequently.
    I moved into a boot, not Vasco boot after two weeks. With wedges in that were removed one at a time every three weeks. Boot comes off in two days( scary!). I was told no exercises at all. Boot on 24/7 a.only removed to wash. So that’s another different protocol.
    What I am trying to show you is that, as pegleg says, there are lots of different hospitals working to various protocols. I did alphabet and some gentle ROM movements that people on here had done. Important thing I think is: Listen to your own body and don’t rush it but do try to gently keep things moving. Someone mentioned give it healing time before pushing mobility. I’m sure you’ll realise, the more you read, that everyone gets to the same point . It just takes some a little longer. My mantra has been:
    It could be worse and its not forever. Stay positive n do what you can when you can. Good luck and keep us up dated. Take care.
    S

  9. blondie Said,

    August 19, 2014 @ 6:44 pm

    Hi all,

    So I am not prepared to be a couch potato and intend to do all I can to recover as quickly as possible in the safest way. I am Already moving my toes and clenching my calf within the cast when I can.

    I am feeling very lost and confused and appreciate you don’t know me but I am a business women in control of my life and have found myself in this situation and have lost my confidence temporarily !!! I hope

    I have researched ipswich and they have no printed protocol for recovery. Since seeing the consultant when diagnosed and put in plaster I have not seen him since. My husband came with me to my appointment yesterday and I went armed with questions, but I saw a nurse who put the metal heel on told me this would help me get about and that I could start to put weight through my foot with crutches. She told me the next two weeks is the best and when I come back on 1 September they were going to cut the cast to start my foot moving but would give me more info on my return. My husband interpreted this to mean they would cut a small section at the front of the cast to allow my foot my toes up slightly?

    I would have loved an outline of my treatment over the next 8 weeks, but its not available.
    For now I am going to trust that they know what they are doing and I will do everything I can to aid my recovery for myself and do all I can to keep my spirits up and I am a positive person by nature and I do Appreciate all your comments And support.

    Still feeling vulnerable and frustrated but got. Great network of friends And family around me but peg leg you are right I am still in the stage of panic and unknown and that is a little scary.

    a positive to end on the calf pain is nearly gone, the Intense pain when leg Down has also gone . Only taking a couple of painkillers a day now, so that is all good.

    Thanks for all your comments

  10. blondie Said,

    August 19, 2014 @ 6:50 pm

    No sport thank you, you just described my pain well and that alone makes me feel less alone.

    Hope all goes well for your boot coming off in two days x

  11. Stuart Said,

    August 19, 2014 @ 11:17 pm

    Blondie - the first few weeks is probably the hardest mentally. Once your mind capitulates to the injury you start to see things with greater clarity. It is a long recovery but life can get back to some kind of normal fairly quick depending on what normal is for you. I can remember the feeling of total loss when it happened. We were days away from starting to build the new house and moving to the farm we had bought. All was put on hold until I was fit enough to climb ladders etc. We now live in that house but I have been laid up again for the last 3 months with another tendon injury. Maybe the ATR taught me something or the pressure was off but I have dealt with the current injury better. I would not wish and ATR on anyone but there are considerable life lessons to be learned from it. Take it easy and if need be take a break from these pages. We all want the best for you but it is really up to you to follow your own path.

  12. Pegleg Said,

    August 20, 2014 @ 2:49 am

    Hi Blondie

    That’s exactly how I felt and why said what I did, have faith, stick in there and it will all come good in its own time. I too am a business woman I have my own business but I learnt to make it take a back seat for the first few weeks to help initiate healing and for me to adjust mentally (this for me was the biggest task). You sound like you are doing the correct things for you and that’s what is most important :-)
    Glad to learn the pain is going and sure it will only improve more. Take care and look forward to hearing of your progress.

  13. andrewc Said,

    August 20, 2014 @ 5:40 am

    Hi Blondie

    I think that Hillie’s comment covers most of what you need to know re treatment protocols.

    You really do need to keep positive and to take control of the situation. I am now 67 weeks post my rupture and I can honestly say that although it was a very frustrating time, it is also possible to turn it into a positive experience.

    I managed to get back to a decent amount of exercise by 16 weeks and was fully back to my normal routine (at a slower running pace) by around 22 weeks. I also did not lose a single day of work as a result of my injury.

    I would recommend that you have a look at kellygirls posts for some inspiration and also have a look at my posts (andrewc) for some early exercises.

    I would recommend that you take control of the situation as much as you possible can in order to get the best and fastest outcome.

    Good luck and keep positive.

  14. Ying Said,

    August 21, 2014 @ 2:42 pm

    Hi Blondie. I too am currently being treated at ipswich hospital and like you am a bit frustrated at the lack of information. I also had the metal heel attached on 11 august. It looks ridiculous and standing at the train station I get funny looks too! However, It does help with getting around as I can now sort of walk up stairs one step at a time and holding the rail. I can also hobble around the office and home without the crutches, help with being able to carry a few things, best of all can stand up for a shower. I go back to hospital on 25/08 to have foot of the cast cut out. I post you if I can find out any more about the ipswich hospital protocol. Hang in there, I’m sure the hospital knows what they are doing and 8 weeks will fly by and we will be out of the cast and almost walking again. On the positive side, using crutches to get around is not a bad work out in itself!

  15. Kim Said,

    August 27, 2014 @ 2:14 pm

    Hi Ying,

    Good luck at next appointment let me know how it feels once front of cast is cut.

  16. Ying Said,

    August 27, 2014 @ 5:09 pm

    Hi Kim
    Been 2 days since front of cast cut off. Whole of the top of foot is exposed. Able to move foot, nurse advised that means tendon had reattached itself. Next appointment not for another 4 weeks, will then seen doctor, examined, cart taken off and then possibly a boot fitted. I did ask if I should be seeing the doctor for check ups, but was told not needed! Over next few weeks have to excercise the tendon - just moving the foot up as much as possible to stretch tendon. Tendon feels tight but it’s a nice feeling. When the piece of cast was cut off, foot swelled and some bruising on top of foot appeared. Got bit more pain in calf now some odd pains around tendon, but nothing needed pain killers. Would have liked a boot fitted but will just have to keep hobbling! Are you in a heel thingy too?

  17. blondie Said,

    August 29, 2014 @ 4:25 pm

    Hi Ying
    Thanks for the update, sounds like you are doing really well. I can also now manage stairs with the metal heel attached. You mentioned standing on the platform and walking around the office are you back at work? If so you have my admiration. I have been signed off for 8 weeks but have agreed with work that i will pick up what I can from home on laptop and have arranged meetings with some of my team so they can still feel supported and I can feel some sort of job satisfaction and keep my brain alive!!

    I am back to Ipswich hospital on Monday for my cast to be cut, mixed feelings as this week has been the best pain free and mobile week so don’t want to go backwards, will let you know how it goes. Do keep in touch about progress, your doing well x.

  18. Ying Said,

    September 9, 2014 @ 6:48 pm

    Hi Blondie, just checking how you were doing, sounds like you making great progress.
    Well, just 1 1/2 weeks to go with cast and injections now. Not a good week for me, big toe and foot swollen and throbbing! Saw doctor who said to take pain killers. 2 ibuprofens every 4 hrs and 2 paracetamols inbetween. Rattling with pills, but it’s working! Tendon feels tight when stretching still, but can get 90degree angle (I think!). Hiw your stretching exercises going?

  19. blondie Said,

    September 10, 2014 @ 5:45 pm

    Hi Ying, poor you, sorry to hear you are having a bad week. I have been really lucky very little swelling and able to move foot up and down. Like you really tight tendon not anywhere near 90 degrees though . I am back on 28 September to have cast cut off and feeling both very anxious and excited, did they say they were going to give you a boot when cast comes off, as not sure how you leave the hospital when They cut off?

    I stopped injections 3 weeks ago as I got a bruise that stretched across my stomach looked like I had been beaten, and have a small lump which if it does not go by next week will get checked out.

    Keep smiling, not long now, hopefully when they take cast off all the swelling will go.
    Keep in touch
    Kim

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  20. Ying Said,

    September 19, 2014 @ 4:14 pm

    Hi Kim
    Good to hear you in good spirits. That brushing of yours sounds like its needs seeing. Got some bruises too (1 a day! And just 3 more to go), but they disappear after a week. Hope your bruising fades.

    My cast comes off on 22nd Sept. Never have I been so looking forward to going to a hospital! I’m not sure if they’ll put a boot on or not, the plasterer was quite vague last time. I’ll post you with the results on Monday.

    The last week in cast is going really quick, can’t wait to get to that itch in the cast!

    Your almost there too now, good luck and take care.

  21. Kim Said,

    September 21, 2014 @ 5:59 pm

    Hi Ying

    Good luck tomorrow hope is all goes well
    Let me know how you get on
    Kim

  22. Ying Said,

    September 22, 2014 @ 1:46 pm

    Hi Kim.
    Cast came off today. Great feeling. No special boot. Quick examination by doctor said it had healed back and now needs the stretching and get strength back in leg. Can’t walk yet so still on crutches. Feels so much lighter. Leg muscle is floppy and a lot smaller (and pale!) than good leg. Physio straight after doctor, shown some stretching exercises to do and back to physio 30th sept. Been a few hours now, no pain and feels great to out of the cast.
    When you go next week, take some trainers with you as they are more comfortable. Also you’ll notice loads of dead skin on your heel, good soak and scrub with exfoliating brush and all gone. Wife being a beautician came in very handy!
    Good luck with next week, I’m sure you’ll feel just as great and relieved, not long now! Might even see you in physio!!

  23. Kim Said,

    September 22, 2014 @ 3:48 pm

    Hi Ying,

    Fantastic news, so pleased to hear it went well. Will let you know how I get on but keep in touch let me know of your progress.

    Not sure if my husbands many talent run to soaking my feet, but will let you know!

    I feel really nervous and excited now just counting the days.
    Yes might see you in physio, would be nice to meet my fellow sufferer.
    All the best for continuing to get fully healed
    Take it easy!!!
    Kim

  24. Ying Said,

    October 10, 2014 @ 4:14 pm

    Hi Kim
    Just seeing if you had your cast removed and hope all is ok with your achillies?
    How you finding physio in ipswich hospital?
    Hope you are healing well.

  25. Kim Said,

    October 14, 2014 @ 5:45 pm

    Hi Ying lovely to hear from you. Yes had cast off two weeks ago… I was very apprehensive to begin with but was lovely to have cast off. Physio were really patient with me getting my heel raises in my shoes and getting me on my feet. I went back today for review and whilst I am doing well I still have a lot of swelling and very little movement on my calf, so I am still on two crutches, two heel raises and now also got tube grip to help with swelling for another two weeks. I still can’t shower without shoes and heel raise for another 2 weeks.

    I am back into my workplace on Thursday but have been working at home for some time now, I am still not cleared to drive.

    I did say to physio today Could i think about doing anything at the gym or swim and he told me I was still a way off excising normally I had to concentrate on putting my leg straight not it to the side!!!

    Would love to know how things are going for you. Are you still at physio and how is that progressing for you. Do you have redness and swelling etc.
    Take care Kim

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