Update - 6mths
Well, I though i should post an update, since its been good to catch up on how everyone else is going post-blog-hiatis!
So Month 4.5 to 6 has been huge for me. At 4.5mths (Christmas eve) I could walk for 10 mins on the flat, pretty much OK and do maybe 20 mins easy spinning on the bike. Holidays started and I was FREE, I have had a full 8 weeks off with my only goal (other than going to weddings and similar festivities - its summer here) was fitness. I spent an hour on the windtrainer 5 days a week for all of January including lots of intervals, standing sprints etc as i got fitter and stronger. I walked most days, worked up to 30minutes within about 10 days of Xmas, then onwards to hills and longer walks….I did yoga most days, and my PT exercises every second day. Needed all the rest of the time to rest!!
I’m now comfortable walking for 2 hours off road, hills and all. Today I did that after riding for over an hour this morning!! (I’m shattered). I’ve also been out mountain biking a couple times and had my first surf yesterday! Planning, wind permitting to have my first windsurf tomorrow… All good!!
I’m seeing my physio every 2 weeks now. Focus now is on rebuilding glutes and legs (i.e. so I can do several hours of decent exercise a day without being so tired!) and more and more calf raises, and still working on some jumping, hopping and agility stuff, stuff to work the neural system, and balancing on an air cushion/wobble type thing. So still lots to do. Just got to keep up the motivation - it gets harder when you’ve felt tired for 6mths. The sport/exercise I love, the physio is more of a chore…
so it has all come together well. Wouldn’t say its normal but its pretty damned good (I have very high fitness standards). Cardio fitness (I puff walking up hills still) and lack of muscle aside, I still have some slight weakness when I first step out of bed, the calf gets very fatigued after a good bike ride or hill walk, and my ROM is still a couple cm off. I don’t think i’m quite ready to “jump off a wall and land on my bad foot” which the hospital physio told me I would be able to do when fully recovered… Oh and no squash or indoor football for another 4-6 months by which time I suspect I’ll have found something new to do anyway 
I can thoroughly recommend taking some time out in summer to get fit ;). Unfortunately, both not working and summer are both coming to an end 
which leg was it?
Haha. Not quite, but my physio said yesterday that the muscle has built up really well and you can hardly tell the difference between my calves when I do a calf raise. The work (and i’m religious about doing it) has been well worth the effort. Reckon this stage (15.5 weeks) is where it all comes together.
Where i live its almost impossible to get from any A to any B without going up or down hill, so from here in i’ll be working on that without the limp, because that’s the main outstanding issue now
That elusive “push off”
Today I found myself walking. Suddenly realised I was pushing off the ball of my foot and the gimp walk had gone (it didn’t last, fatigue set in pretty quick). Stopped, astounded and tried a 1 foot calf raise just to check. Got about 1.5 or 2 inches inches high. All those calf raises i’ve been doing have finally delivered a result. Very exciting for me. The workmate I was near at the time was less enthusiastic though he tried
Was that 13 weeks or 14…?
You know you have made progress when:
1. Someone asks how long ago you had the ATR and you can’t tell them in weeks AND days (in fact, I could not recall if it was 13+ or 14+ weeks, but i’ve checked and its the former)
2. You find yourself jay walking when there are cars coming
3. You walk a couple of steps properly - providing about 3 seconds of complete normality.
I did all of those yesterday. And yes, I made it across the road before the car got to me (though not with my ‘proper’ walking gait that I am trying to relearn!)
So progress: walking is improving. I can walk, if I’m slow, without a limp, but only between 8am and 4pm. Before 8 its stiff and after 4 its tired. Though today it was 5…bonus!
I can do 30mins on the stationary bike, and actually raise my heart rate over 120 for the first time in months. Oh and i’m lapping the 80 year olds and pregnant women in the aqua-jogging lane
Question - when did people start to get the ‘push off’ in the ball of the foot (for walking). I’m getting a tiny bit, but nowhere near a single calf raise, and not for lack of work!! I know others are walking at 10 weeks or so, but when does the push come…? thanks
Define walking…
Well today I had my final hospital appointment…at 12 weeks they say goodbye in this part of the world.
Sort of an anticlimax.
I think the problem goes back to when i got my first cast, they told me “you’ll be walking in 12 weeks”. Unfortunately, I didn’t ask what their definition of walking is. In retrospect I have realised that their definition and mine differ by about 10km per day…
And my walking is not improving. Lots of other things are: balance, leg strength, walking in the pool, energy levels. I just need to remind myself that they are all progress towards the ultimate goal. But its still …disappointing. I have completed (today) my first alcohol free month since I was about 17 so maybe I should celebrate that!
While I remember, the doc i saw today (aged all of 25) said they are looking at doing a study at Wellington Hosp (where I was) into the 2 week casting then into a moon boot. I guess everyone is looking for improvements to existing protocols. Wish they had been doing it 12 weeks ago!
NZ study by Twaddle et al
Hi all
Awhile back I said I’d emailed Bruce Twaddle who was one of the authors of the NZ study that Norm has referenced which looked at operative and non-operative recovery and showed similar results for the two. Anyway, he responded with his protocol which he was happy for me to post here (”Knowledge is Power”). The same protocol was applied to both operative and non-operative. I don’t have the full results but you can see the summary on Norm’s blog I think.
In addition to the protocol I asked him about heel raises in particular (as I went to heel raises for the 8-12 week stage) and he commented that while he isn’t a big user of heel raises, he recognises that some people feel more comfortable with them for awhile (i.e didn’t seem to think there was a problem with that). I don’t want to get into a conversation about surgical /non surgical here, but he also commented that he doesn’t see any place for surgery in the primary treatment of ATR even in elite athletes - he will operate if people want it, but would apply the same rehab.
So here it is:
1. For the first 2 weeks after injury the patient should be immobilised in a hanging equinus pop (not forced equinus) and be mobilising non-weight bearing.
2. After 2 weeks up until 4 weeks from injury the patient can be placed in a removal orthosis set at 20deg of equinus. The patient is allowed to remove their foot from the boot for 5 minutes of every hour and move their ankle with dorsiflexion and plantar flexion, being careful not to come beyond a right angle, as the greatest risk is having a tendon that heals long. This should be repeated 5 minutes of every hour where possible.
3. At 4 weeks from Injury the moon boot is brought to 10deg of equinus and the range of motion exercises continue, being careful again not to bring the ankle beyound a right angle position. The patient can be touch weight bearing through the toe of the boot , up to 20kgs of pressure, from 4-6 weeks.
4. At 6 weeks from injury the patient can bring the orthosis to O deg and begin weight bearing as tolerated, weaning himself/herself off the crutches by 8 weeks from injury. They need to continue on with the range of motion exercises of their ankle and can remove the orthosis at night.
5. At 8 weeks from injury they can come out of the boot and start toe raising exercises, increasing the weight bearing on the affected leg. When they can single leg toe raise and support their own weight they can start a stretching and strenthening programme and increase their activity level according to their symptoms. This should allow them a quick and full a functional recovery as possible.
the world is opening up again
We had a long weekend just gone and for the first time I could do more than 1 thing per day! (My joke was that in any day I could go out for coffee, to the supermarket, or to work - but not more than one of those in a given day!) This weekend I did heaps of stuff and had more energy and motivation by a long shot…and didn’t have to sit down every 15mins. How great - and how sudden. Funny, I thought month 3 was the ‘danger zone’ but i’ve realised that the real danger starts now, you know, being invincible and all that
Well, when i last posted about a week ago i’d had two physio sessions. Since then i’ve had 3 sessions in the pool and another two with the physio and have been religiously doing my physio exercises (about 20-30mins per day) and the world is a new place! Suddenly the walking has improved enormously (still not much push off the ball of the foot though), the stretching is helping heaps. And the pool has helped alot especially mentally! The first session was a shock as i was standing on the edge, and for no reason suddenly had tears running down my cheeks! I think it was the first thing in 10 weeks that was outside my comfort zone and it was a shock! No worries since though.
So, in terms of the hydrotherapy, my PT sets me exercises to do and I go to the pool with a friend who swims most days. I walk up and down the pool and do my pool exercises for 20mins, then 20mins aqua jogging. I’m SO tired by the end of that! And this week I start cycling too…………………..! (couple minutes at a time that is!)
So suddenly i’ve gone from feeling like i’m in a holding pattern, treading water, to being able to plan stuff. Yay.
Happy Place ;)
2nd physio session, very happy with progress. starting to do more stretching along with the strengthening exercises for upper legs and glutes. And into the pool this week. We’ll probably start assisted calf raises next week and proper ones after week 12. Exciting times. (I can’t tell my friends this, because really its not very interesting for them). But most of all, I feel like i am getting my life back! As I live alone (but for a flatmate who is away most of the time for work and does not drive besides) it is nice to feel like I am getting some independence back!
Where “should” I be up to: non-operative at 9wks 5 days?
I was having an offline chat with Norm and was about to reply to his comment, then remembered I’d said i’d talk about ATR stuff on the forum.
So I’m non-operative and following a protocol that is used in Wellington, NZ. I don’t know what the basis for it is, but it works as follows:
4 weeks in cast with toe down (NWB)
2 weeks in “moon boot” NWB
2 weeks in moon boot with 2 heel wedges and FWB
4 weeks in two shoes both with a heel raise of about 3/4 to 1 inch (FWB).
Norm’s comment was: “I’m not sure that ANY of the modern studies used heel wedges after 2-shoes. I know that UWO did not, so I did not. Maybe the 2007 NZ study did, and it has warped — err, influenced — NZ practice ever since? Based on UWO’s results, it may be a sensible-sounding nuisance with no real benefit — and maybe one more thing for you to ask your Doc to justify, preferably with Evidence-Based Medicine.
My question is this: I’m fit, healthy, and i think its healed well. But my achilles seems very short, as in, i can stand on both bare feet but I don’t have much bend in my right knee (I did my right AT) so when i walk I am kind of pulling my leg along rather than walking (a marked limp and very slow). There is no way I could walk without the heel wedges (well not more than a couple steps anyway). Should I be able to? Has something gone wrong? I saw a doc at 6 weeks and he was happy with progress and said come back at 12 weeks. Off my own bat i’ve started physio, the phys seems to know what he is doing, knows of hte UWO studies etc and didn’t seem too concerned. What should I do??? Where are other non-ops at at 10 weeks? Can you walk in bare feet? Limping? I know you can’t compare with others but I thought i was doing OK and now i’m wondering whether something is wrong.
thanks in advance
Is it normal to be this tired?
Just wondering…is it just me, or is there something really tiring about this process?
I used to be very active (10-15 hours of good, hard exercise per week) and now i’m doing very little (20mins of upper body and core workout every second day, and just getting through sort of stuff) yet I seem to tire so easily!
Is is that (a) i’m just a slacker at heart (b) that dragging my leg around is more tiring than you’d think, or (c) the body is doing something that releases lots of tired hormones…
