To recap my protocol to date:
Splint (NWB) - 2 weeks
Cast (NWB) - 2 weeks
Boot (NWB/ROM) - 2 weeks
Boot (PWB - FWB) - 2 weeks
Boot (FWB - 2 wedges in heel) - 1 week
Boot (FWB - 1 wedge in heel) - to date.
Had my first few PT appointments this week. First off, really clicked with my therapist…he’s an avid outdoorsman, and although has only worked on a few AT’s in the past year, he did work with a competitive male cheerleader (one of those big guys who holds those 95 lb girls up with one arm) and was very successful. I told him that I was a little concerned about a re-rup in PT, and he said that he likes to take AT’s pretty slow at first, so I should have no worries.
He was very impressed with my low level of swelling and ROM. I told him about talking my ortho into a boot at 4 weeks and he thought that was a good idea. He took some initial measurements. My calf on my injured side was 4 cm smaller (in circumference through the thickest part) than my good side. Doc Ross mentioned an average muscle loss per week of inactivity..wonder if this is in line?
Next was some massage, primarily around the tendon and scar, but also quite a bit on the talus as my plantarflexion is currently a lot worse than my dorsiflexion. The tendon was fairly sore during, but it was a good sore, like any deeper massage.
He moved on to ultrasound and cold laser. The ultrasound was also a bit painful as it rubbed around the tendon and scar, but the cold laser was completely pain free. We finished with E-stim and ice for 15 minutes.
He mentioned Superfeet again, and I knew it was finally time to get a pair. Boy what a difference. I got the green version, and put them in my boot. I am supposed to return to my next ortho appt in 1.5 weeks with no wedges in by boot. When I moved from 2 wedges to 1, my heel was really irritated. Once the superfeet insole was in the boot, there was no discomfort with 1 wedge. I plan to go a few more days with 1 wedge, and then remove that one as well.
In leaving the appt, he wanted me to start some light theraband work (planterflex). We had to go with the lightest band, in my case that is yellow. It is funny how my ankle/calf/tendon just wouldn’t fire with any resistance on it. I could planterflex fine with no resistance, but with just a little resistance, it wouldn’t work. I kept at it for the first few days, and I think it was more of my muscles needing to “relearn” that motion with resistance, because I am doing it fairly easy now.
My second PT appt was yesterday, after one day in between appts, and there was a noticeable improvement in my dorsiflex and the swelling level in the upper tendon area. He said the tendon is sliding nicely in the sheeth, and to keep massaging the tendon upwards towards the calf to get any of the swelling gunk out of the sheeth and into the limbic system. Along with ROM, and the planterflex with the theraband, I am to start using the theraband to pull a little dorsiflex to stretch the tendon a little more, no weight bearing stretches yet.
I have a couple more PT appts scheduled next week before my next ortho appt. I have a copay for each PT visit, so I’ll just have to gauge when I feel like I’ve gotten all I can from the modalities and information they provide on exercises. I don’t think I’ll be able to go for too long though, as it gets expensive quick. But I figure now it’s an investment in my long term health and activity level, so it’s money well spent.