Posted by: chocolata | 24 February, 2010

DAY 2-3


When I woke up, I confirmed that I had ruptured my right AT last night.   It was not the night dream, unfortunately.  As far as I sat on the sofa with my right leg up, it didn’t hurt.  I could move the toes up and down slowly with no pain.

However, later the evening I felt numbness in the big toe.   The edge of the half cast was pressing my foot.  I tried to lower my big toe as much as could while sitting on the sofa to release the pressure.   I went to bed about 11 pm.  I was so sleepy, since I couldn’t sleep well last night because of the nausea caused by the laughing gas (and shock from the injury?) .   At night I was woken up many times by massive pains in the foot, especially in my big toe.   I changed my sleeping position to avoid further pains and struggled all the night.


Early in the morning I got up in tears and sat down on the sofa.  I put up my foot higher than the heart, but the pains didn’t go away.   My husband woke up a little later and came to check on me.  "How are you feeling?", he asked.  No word came out of my mouth because of the pains and worries.  I explained the problem to him and burst into crying.  He checked the cast and my toes and we decided to call the Orthopedic Outpatient to request re-casting.   I had to walk down the many stairs with a crutch again (from the 3rd floor, in USA 4th floor), but it didn’t discourage me to go to the hospital.

I saw a doctor in the afternoon.  Before seeing him, I was taken to the cast room in a wheel chair.  There were two technicians (I still don’t know how to call them!).   One of them asked me what’s wrong with the cast and I explained.  He told me that they didn’t have professionals for casting at their A&E and that’s why I got the half cast which was not appropriate for the ATR.

A doctor walked into the room and I repeated the same thing.  The half cast was removed immediately and two red spots were observed around the root of my big toe.  When the doctor touched them, tears welled up in my eyes.  The pains gradually eased down.  The technician put a glass fiber cast gently on my foot/leg and gave me a candy!   I suppose I looked so poor to his eyes.   The new cast was comfortable with round edges.  It covered around the foot/leg (under the knee) and my AT was not exposed anymore.  Here is a question.  Why didn’t I get the proper cast in the first place?   A English friend of mine told me that this was because I was treated at A&E.  To me and my husband, it didn’t make sense.   Casting should be done properly in the first place at any hospitals.

On this visit, I think the doctor spent 3-4 minutes with me in total.  After the initial cast was removed, he looked at my AT and said that it was ruptured.  Nothing new to me.   He then told me to make an appointment in 4 weeks time and walked away in haste without giving me a chance to ask questions.   I think I looked puzzled then.  This visit was supposed to be an opportunity to hear about my treatment protocol, wasn’t it?

The technician helped me to move from the chair used for casting to the wheel chair.   He showed me how to insert a crutch under the seat to make a space to put my injured foot on it.  This nice chap then told me to bring a shoe for my ATR foot with me to my next appointment so that they could prepare wedges to put onto the shoe.   I wanted to know more about the suggested supporting gears but didn’t have time to ask questions because the next patient was coming into the room.

I went home in my husband’s car where the long stairs were waiting for me.  My arm muscles are not strong and pushing up the crutch to carry up my body is more demanding than going down.  As far as there is a rail to hold on to, I think going down with one crutch is much easier.

With the new cast, smiles are back on my face!


You Poor Lady.

Take it easy…and scoot up and down the stairs on your bottom side. There is no shame in that, I did for the whole time I was in a cast.

Good Luck.

So, obviously you’re going the non-surgical way. Or you haven’t been advised of none of the ways? Was that doctor the same he put you on the first cast? If not, didn’t anyone of them scheduled you for another visit?
Don’t worry and don’t cry. Even if you feel uncomfortable with the cast, go ahead and adjust it on your foot the way you feel it’s okay, not hurting any part of your foot. I had same issue a couple of nights and I did it myself.
And don’t take candies from strangers :-P

So familiar…. I was given the wrong cast at emergency : 90 degrees angle. 2 days later at the orthopedic surgeon the technician was just shaking his head seeing it. I got a proper fibreglass cast then with pointed toes, but it felt too tight so I went back to emerg 3 days later. They cut it but did not have anyone to make a new cast so I held it together with duct tape until I could see the orthopedic guys. (available only once a week)

They did not teach you how to go on stairs with crutches???
You are supposed to hold the 2 crutches together on one side and hold on to the rail on the other. Never go without holding on to something stable with one hand!
Indoors I went down on my bum up on my knees, no crutches.
Take care.

P.S. I love flamenco.

Hi Chris,
Thank you for your comment. It made me laugh! I will make the most of my bottom from now on :)
How’s your ATR healing going?

Hola marina,
I’ve been treated 2 different doctors so far - one at A&E (ER) and the other at Orthopedic Outpatients. The second one told me to come and see a doctor in about 4 weeks time (i.e. 10 March). On the NHS treatment, unfortunately, patients don’t seem to be able to see the same doctor. This is my 3rd week after the ATR and my cast is getting loose now. If it starts making more space around my AT and doesn’t hold it well, I should visit the Outpatient earlier for re-casting.
Marina, how long have you come after your ATR? How’s your AT?
Your messages encourage me and I want to give you candies :)

Hi 2ndtimer,
Oh, dear.. Your experience with your first 2 casts sounds really awful. I’m sorry we both went through such troubles. No one at A&E asked me if I knew how to use crutches when they gave me a pair. They dropped them beside me and disappeared in a second. Luckily, my husband have used them before and I also had been a user long time before. So it was okay, although he misremembered where to put the tip of crutches when going up the stairs :)
Do you dance/sing/etc flamenco?!

My healing is going as well as I can expect.

I just hope by the time all the cold weather and the snow leaves, I’ll be ready to get back outside running and playing like a little child.

Maybe I’ll even try to act more like an adult too.

Thanks, chocolata, my AT seems to go just fine so far. I’m getting frustrated some times, but that’s how I am, impatient.

my surgery is schd. for next week, my injury is a couple weeks old, and i still have swelling in my leg, just wondering is swelling is normal still?

Of course it is. I have a REPAIRED tendon and is still swollen.. :-S

No, I do not dance, I just like to watch it.

There are many approaches to stairs with crutches — NONE of them completely satisfactory! I’ve always gone up stairs “free hand”, like crutch-walking on the level. There are a few tricks that make it easier on the arms and hands.

First, either modify the crutches to save your hands (foam-rubber padding, rounded sharp corners, etc.) OR wear gloves.

Second, lifting your body weight up 8-12″ with your hands and arms — especially if you’re doing it for THREE flights of stairs — is serious exercise. One good trick is to do as much of the work with your “good” leg as possible, and as little as possible with your hands and arms.

The way to do that is to lift yourself up as high as possible just before you make the “leap of faith” to the next step up. Extend your leg and body as straight as a rail, and maybe even go up on our “good” toes. (You’re a dancer, right?) I preferred to shift my “bad” foot so it was over (and later gently leaning on) the next step, though “your mileage may vary” on this.

Then, as you move your “good” foot to the next step up, do it WITHOUT lifting your belly button! I.e., step into a semi-crouching position, so the crutches only hold your body at the SAME height, rather than lifting it up. Then, straighten your “good” leg to lift your body and get ready for the next step.

Going down can be done in a similar way, and that’s what I did 8 yrs ago (first ATR). THIS time, my banister is on the same side as my “bad” leg, and it was MUCH easier to put the crutches together and lean on the banister on the way down.

I wouldn’t worry too much about your cast getting “roomier” after 3 or 4 or 5 weeks, within reason. A boot is better than a cast in many ways, and being able to adjust it is one of the ways — but having it a bit looser as time goes on isn’t the worst thing, as your leg starts healing and you move toward more WB. All of us had some “shrinkage” in our “bad” calves.

Being able to see the same doctor all the time is only an advantage if that doctor is better than average! :-D (Aren’t you glad you’re not repeatedly seeing the same clown who put you in the wrong cast?)

Here in Canada, government insurance pays for all the doctors, but we get to choose which one we see (at least in a big city like Toronto, which is very well “doctored”). Works for me, though I’ve only seen my doctor for two short visits in over 10 weeks, and I’m not sure when I’m supposed to see him again. If things keep progressing well, who needs a doctor?

Hi normofthenorth,
It’s very kind of you to give me useful information about approaches to stairs with crutches! I will them when I go out next time :)

My cast is getting more roomier and I feel some stress on my AT from time to time. Yesterday I put a handkerchief in the cast around the top edge to fill the room and it helped, but I’m not sure if it’s good. I’m going to call the Orthopedic outpatient on Monday to ask what kind of cast/boot in in Week 8 after my ATR, since I’m flying to Japan then and the airplanes would only allow a passenger to fly with a cut cast or boot (to allow for quick removal if swelling occurs). So when I talk to them, I will ask a few more questions which have been occupying my mind.

I think there are two things a cast or a boot does — one of them very important, the other one much less important.

The very important one is immobilizing the flexion angle of your ankle — initially in plantarflexion (”equinus” = like a horse), then shifting toward neutral. Some surgical patients just get a long bent (L-shaped) splint that’s held securely to the front(?) of their leg and foot with wrapping. (That’s what doug53 had until he went straight to shoes in record time.)

This is important because the angle of your ankle directly affects the position and length of your AT, and you don’t want that shifting around, especially while you’re waiting for your body to re-connect the ends of your tendon, with the non-surgical option. (Some say “conservative”, but I bristle at that term when initial immobilization is combined with rapid and aggressive rehab. Aggressive conservative?!?)

If the upper cuff of your cast can wobble a lot around your shrinking leg — especially forward and back — that’s a Bad Thing, and wrapping your leg with padding to prevent that wobbling is a Good Thing, IMHO.

The other function is to provide a secure and comfortable immobilization “bed” for your foot and ankle. Moving toward WB, the “sole” has to support your foot well, of course, like a shoe. But before then, most surgeons want your foot contained so your foot can’t do much rotation in the other directions, either (eversion and inversion and the other two = toes left and right).

I’m not sure the surgeons are correct in that desire, at least after the first few days. I don’t think there’s much chance of hurting the AT itself with a few degrees of those other kinds of rotation. On the other hand, any movement may be harder on the incisions than total stasis — but if total stasis means a lot of pressure on the incision, I can see it going the other way!

And opinions differ STRONGLY here on the role of COMPRESSION after an ATR. Doug and some others have intentionally applied compression to control swelling — either along with elevation and icing, or as a replacement. (You know “RICE”?)

But most of us have felt much worse whenever the swelling of our leg reached the limit of the boot, or especially the cast. Personally, I was much more comfortable loosening my boot when my leg was “big”, rather than getting the supposed benefits of compression from a tight boot. (”RIE”?)

In short, I wouldn’t worry about the ability of your foot to wiggle from side to side or rotate a bit around the axis of your foot. At 2 weeks, I was supposed to start doing those wiggles inside and outside my boot — without ever lifting my foot past “neutral”, of course! But your angle of plantar-flexion should be secure, IMHO.