Counting the days…

Bronny, at 10 weeks, most of us can’t walk quite normally for two reasons. Lack of calf strength to “push off” at the end of a stride is the near-universal one you haven’t mentioned.

What you have mentioned is a deficit in ROM in the dorsiflexion direction. Assuming that everything’s healed up (AT) at roughly the right length, that’s just a matter of loosening and stretching until you get the ROM back. It’s got to be done gradually and carefully, because over-stretching is a Bad Thing.

Your protocol is keeping you plantarflexed much longer than most, so it’s not surprising that your AT feels short. Others have been near the other extreme, and had nasty pain when forced into the neutral position only a couple of weeks after starting (post-op or non-op).

The long-term heel wedges are a kind of “crutch”, and we all know that crutches have their place, but also that it’s a limited place, so it’s a tradeoff. I’ve never read the entire 2007 NZ study that produced excellent results with and without surgery, so I don’t know if it’s the source of the NZ practice. If so, it seems to work! It could be interesting to compare their success with the other studies, which did it slightly differently, and maybe go with the best one.

UWO’s cold-turkey withdrawal of heel wedges at 6 weeks (bit.ly/UWOProtocol ), and various schedules of more gradual wedge removal, also work. Eventually, you’ve got to be comfy in normal neutral-position shoes, and dorsiflexing in them when you walk — and go down stairs, and play sports, etc. 12 weeks seems like a very long time before getting to neutral, but if the evidence shows it works better, we should all do it!

Hi Norm
You’re right, i don’t have much “push off” the ball of my foot, though that is improving - particularly in the mornings when the muscles are not tired.

I have emailed the guy in Auckland who wrote the study asking if he can send me a copy, or if not, tell me if what I am doing is consistent with the “early mobilisation” protocol they followed. I’ll keep you posted. I’m hoping the 1.3 degrees of separation we apparently have in NZ will work for me here

My physio has also said I need to stop fearing standing bare feet on my right foot, so I am doing some barefoot weight shifting exercises and attempting to walk short distances around the house, i.e. where its really safe.

I think alot of this is - and it probably applies to all of us - knowing what is safe and what is not. The Physio said to me that it is perfectly safe to put plenty of weight through my right foot without the heel raise, I didn’t know that, so now i’m comfortable trying it. You know what i mean.

thanks for your help again Norm.

Bronny, reading your post to norm honestly made me feel great because the walking around the house is exactly what I did and the fear you have and I can only tell you…keep practicing. Not overdoing it but yes your physio is right. Its about mentally knowing what you need to be able to do, to keep moving to your goal. I limped like there was no tomorrow, and I tried and tried and tried and tried and tried to lift my darn leg onto my toes..god, so frustrating, so annoying, so painful. But I’m telling you, it paid off..took a while, had to believe it was gonna come back, and it finally did. The house is the best place for me honestly..did so much on my own, and one day, i had to make a sudden move to avoid a car, and…that’s when i realize..hey, I just did that! I forgot for a second about my limits. It will happen to you also..you will be amazed at what you are capable of..all of us, when we put our minds to it. Always choose safety first..but the day will come very soon for you it seems when you will stand on two feet and limp/walk better, feel yourself finally lift your heel that first little bit onto your toes, finally limp out of your house..for 5 minutes, 10 minutes, then an hour, then a mile. I wish you well and stay strong in the meantime and of course careful