Posted by: chocolata | 2 March, 2010

3 weeks after my ATR

Since I ruptured my AT, I’ve been housebound  for 3 weeks, except one visit to the Orthopedic outpatients to have the first half A&E plaster replaced with a proper cast 2 days after the rupture.  I’m still in the same cast and there is one more week to go.

Nothing much has changed, but over the last 3 weeks I’ve made some progress.   For example, my arm muscles seem to have grown a bit and they are not sore when I walk with crutches.  Although I still need my husband’s assistance when I get in/out of the shower cube, I can now cope with more house chores than in Week 1-2.  Having said that, let me tell some of you guys who have been looking after your kids while you are in a cast/boot, I do admire you!  :)

Yesterday, I found out more of my treatment protocol when I called the Orthopedic Outpatients.   I called them to ask about what kind of cast/brace I’d be wearing in Week 8 because I was going to fly to Japan then.  As you may know, the airlines require passengers like me to put on either a boot or a CUT cast (to allow for quick removal if swelling occurs).

A nurse who answered my call told me that they’d put me in another below knee cast (in semi-equinus position) on my next appointment and that I’d be in it for 2-4 weeks and that boots were not used for ATR treatment.  I wanted hear more about the following protocol, but she told me to ask the secretary further questions because she was not sure if my cast would be cut one when I’d be on board.  And then, the nurse put me through to the secretary, but what I heard on the phone was more than 10 ringing and the following recorded message that the secretary was not in on Mondays.  Yes, it was Monday when I called.  Great.

I’m going to call the secretary tomorrow morning to request a boot.  As some of you wrote somewhere else, boots seem more comfortable and better than casts for patients in Week 5 and onward.   If it is with a hinge, one can use it from Week 5 for sure.

After arriving in Japan, I will be sending out my stuff from my home town to Tokyo and need good protection around my AT while doing the preparation in Week 8 & 9.  Moreover, I will start working in Tokyo from Week 10 and have to commute by train (1 hour with 1 change) and by walk (10- & 15-minute walk) in the rush hour.  Many hospitals in Japan provide ATR patients with a boot, but it takes 1-2 weeks to get one, since braces are usually made-to-order there, believe or not.  So it’s better to get one in the UK before my departure.

In the UK some NHS hospitals use boots for ATR treatment, while some don’t.  I don’t why, but I assume it has something to do with the budget.  I wouldn’t mind to purchase a boot on my own expense, if the hospital won’t get me one.  I’ve actually found a few Internet shops which sell the public several kinds of boots, such as MC Walker and Air Cast.  The best scenario for me is that I can get one from the hospital, but if it’s not possible, I want them to allow me to buy a boot by myself so that I can ask them to adjust it at a right angle for me.  Am I asking too much?

Oh, well.. I’ll leave this to rest until next morning.

Earlier in this post, I wrote how helpful my husband had been, but forgot to mention one thing.   Every evening since I ruptured my AT, he prepared dinner and brought it to me on a tray like a battler.  I’m hoping he will keep this nice service even after I ditch crutches.  :-)

(I know I’m asking too much here!)

Responses

Cute hope at the end, chocolata — good luck with that! (Can you say “Payback”??)

Good luck with your fight for a boot, too. I’ll be pleasantly surprised if your professionals were planning to accommodate the airline.

If you and/or your husband is “handy”, adjusting a boot should be pretty straightforward. Even if you have a hinged one, you can lock it in “neutral” position at first, and use hard-rubber heel wedges to adjust your ankle angle (unless you’re already ready for a “neutral” ankle.

Letting the hinged boot actually hinge — i.e., adjusting it so it can’t go UP beyond neutral, but it can go way down — is something that makes the professionals nervous if it’s done too soon. Mine told me not to do that before 8 weeks were up, but I tried it after 7 weeks and I loved it, and I couldn’t see how it could do any damage. (Whether I was right or wrong, it didn’t!) The hinging just makes your gait a little more natural and realistic, especially as your calf strength builds up. (I’m still working on that, though in shoes this time. 8 yrs ago, I did it all in the hinged boot, ’til I could “push off” normally again.)

All the boots come with instructions. The fixed (non-hinging) ones, like the AirCast, are quite simple.

The hinged ones are much more complex, usually with little steel pins that fit into holes on each side of the boot, to limit the hinging motion. In addition, most (including the MC Walker) have an Allen setscrew (with a recessed hexagonal head) that can lock the hinges firmly. With those setscrews tightened, the MC Walker is actually a bit MORE fixed and rigid than the AirCast (steel vs. plastic)!

My Boot wasn’t a hinged boot, so I guess I can’t add anything to that.

But just take it easy. You’ll be moving around better with each new week.

Keep us posted.

“Payback” - ha, hah, well said, norm! To be fair, I should say that my husband had spent much time in the kitchen with me preparing dinner before I ruptured my AT. (I think I cooked more often than he did in 2009, though!)

Earlier today I called the clinic and talked to the secretary as suggested by their nurse. The secretary said that there was no problem to travel by airplane, but that she was not sure if ATR patients could get a “moon boot”. She didn’t know what make of boots they had and advised me to talk to a consultant on my next appointment scheduled for 10 March (4 weeks & 3 days after my ATR). Very helpful.

Thank you very much more information about the two types of boots you’ve used. A hinged boot (like MC Walker and ROM Walker) seems more suitable than fixed one (e.g. Aircast). I’ve read in someone’s blog about a problem with Aircast’s air bag(?). When it was inflated in the shell, it somehow got a puncture and required air bag replacement for repair. This might have been caused by misuse, but once I leave for Japan, it is difficult to get spare parts. Of course, a hinged boot can also develop some problems in use, though.

I will wait and see what the clinic will offers me. Your comments based on your own experience are so informative and I thank you a lot :)

Anything inflatable can be interesting on an airplane, when the air pressure drops. Water bottles often arrive crushed on landing because of the pressure change. The air bladders in an AirCast would be vulnerable to rupture during takeoff/ascent, and would lose pressure during descent/landing.

I didn’t use the air bladders in my Aircast much. One of them shifted around out of position, but by then I was OK to take the boot off for a while, pull the liner out, figure out the problem, and shift it back.

Hi norm,
I didn’t think about the air pressure problem on board until you’ve pointed it out! If my clinic provides me with an Aircast boot, I will ask a consultant what to do with the air bladders when I fly. Thanks a lot for the input. ;-)

HI Chocolata.
My recommendation would be to check with the airline you are flying with and ask for specific details of what they do and do not allow. Either get that in writing or the full name of the person you are speaking to. Different airlines have different rules for all sorts of things, and it’s a bit late to discover your Dr/nurse is wrong when you are not allowed to check in at the airport! A similar thing happened to my husband over a transit visa for China - he was told in NZ he didn’t need one, but the check in staff said he did. He was fine (he had been to China the month before) but a lot of people missed the flight!

Anyway, I would then use this info as the basis for your discussions with the nurse/secretary, though from my experiences over here, you would need to speak with your Dr/consultant to make changes to treatment protocols.

Good luck!

1) What koolkiwi said!

2) The AirCast boot comes with a little air pump accessory. It looks like the rubber squeeze bulb from a turkey baster, with a little tube coming out each end. One blows, one sucks. You just have to make sure that you suck a bunch of the air out of the bladders before takeoff, or on the way up, or they’ll over-inflate themselves in the dropping air pressure. On the way down, they’ll get flatter, which may make you want to pump them up.

Hi Coolkiwi,
The story about a transit visa for China sounds awful. I’m glad your husband didn’t miss his flight!

Someone’s blog reminded me last week that patients in a cast might need to submit the medical clearance form the airlines (KLM in my case) and I checked their homepage. I found the file explaining the conditions, but several things were not clear. I emailed the section in charge and they replied yesterday that passengers in a cast could fly either in a cut cast or in a brace with doctor’s approval for traveling, and that no document, such as the medical clearance form filled in the doctor in advance, was not required. After reading your comment, I decided to print out the reply to take with me, just in case. ;-)
I have an appointment with a consultant next Wednesday and am hoping that I could get enough information about my treatment protocol. So far no one at the clinic has spent time to give me a chance to ask questions and I needed to call the clinic to get some information about what they usually do with ATR patients. I will request changes to my treatment protocol if it doesn’t meet my need for my traveling (just after 7 weeks after the ATR) and commuting (from week 10). I should prepare well for the appointment!

I’m afraid I may have sounded like a child wanting a toy badly :)

Norm -
Thanks a lot for further detailed information about the Aircast boot! I checked its specification on the manufacturer’s homepage last week, but the information from the user (with kind thought!) is much more useful. Again, while reading your message, I pictured myself sucking the air out of the bladders before takeoff and pumping them up after landing. :)

Hi Chocolata,
I too have an appointment next Wednesday 10th. That will be 7 weeks and 2 days after my ATR. I was in a cast for 4 weeks at full equinus and then put into another cast at semi-equinus for three weeks which will be up next week. I am hoping to get an aircast boot then. In fact the consultant wrote on my notes that I should get one so I am optimistic. He actually nearly gave me a boot at 4 weeks but at the last minute, changed his mind, just to be on the safe side he said! I have been non-weight bearing the whole time. It will be interesting to see how we both fare next week.

Anne, thanks for your comment!
It’s nice to talk to someone who has been on a similar track on the treatment. NWB for 7 weeks sounds a bit too long, but we don’t have many options, do we? I’ve read several papers on benefits of early PWB and on how it can be achieved without a danger of re-rupture. The studies were carried out in Japan and some clinics encourage patients to walk in a boot or in a cast with a heel (PWB) from 2-4 weeks so that their foot/leg muscles and ligaments won’t deteriorate. Actually, a couple of acquaintances of mine who are on this treatment protocol have made good recovery from their ATR. Have you discussed such a thing with your consultant?

I’m glad for you that a boot seems be on your way! Keep me posted, and good luck. ;-)

“Safe side” HAH!! Anne, I assume you’ll be “Weight Bearing As Tolerated” soon after you get into the AirCast. That may bring its own challenges (heel discomfort etc.), but it should get you to FWB pretty soon, which is a MAJOR return to “normal life”!

Just to be able to carry a cup of coffee or a plate of food across a room like a normal person is usually a real “smile”!

Good luck, and keep us posted!

Chocolata and Norm,

I am really getting impatient for next Wednesday now, but at the same time trying not to get too excited, just in case things turn out differently! I know exactly what you mean Norm about carrying a cuppa like a “normal person”. That is one of the things I am so much looking forward to! Isn’t it strange how priorities really change when you are suddenly forced to change you whole way of life for a while with this injury! I keep thinking that I will never take walking for granted again…but of course, I’m sure I will eventually!
How far along are you Norm? It’s so useful to be able to share experiences on this site.

Happy Healing to you both

I’m about 5 or 6 weeks ahead of you, Anne. I was slapped into a boot (by a surgeon!) 2 days post-ATR, on Dec. 10. Follow my progress at http://achillesblog.com/normofthenorth .

I’m now FWB, in 2 shoes, with only a slight limp at the end of my stride, until my calf gets strong enough to “push off” properly again. Except for the little limp, the lack of sports, and a bit of anxiety when I do “ankle-intensive” things (first 2-shoe bike ride was this evening!), my life has pretty much returned to normal, after almost 12 weeks.

Pretty amazing, especially without surgery! This was my second ATR. I ripped the other side 8 yrs ago (both of them playing competitive volleyball) and got surgery. This time is WAY quicker, and much more painless. Now I just have to get a similar result, so I can get back to that scary game!!

My next “firm deadlines” are an April 11 ski week, and May 7, the first sailboat race of the season. (I race little 15′ sailboats, which includes “hiking” = hanging out of the side of the boat, secured with a seatbelt-material strap across the. . . ankles!) So far, I’m pretty confident that I can keep that schedule comfortably — Touch Wood, of course!!

Norm - Congratulations on your first 2-shoe bike ride after your ATR! It was so nice to feel the wind on your face as you biked, wasn’t it? You are 9 weeks ahead of me. Your life is steadily getting back to normal, which is really encouraging to junior ATRers. Your “firm deadlines” are showing that you’re a very active person. That “strap thing across the ankles” sounds really scary, but I’m sure your AT will make further good recovery by May. Good luck!

Chocolata, I faced the “strap across the ankles” issue 8 years ago, after I tore the first one, and it was actually surprisingly easy! Back then, when it was time for the first sailboat race, I felt a bit at risk bicycling down to the club, carrying my bike onto the little ferry boat, etc. But when I finally got into the sailboat and sailed away with my ankles beneath the “hiking straps”, it was all good!

I think it’s because that situation depends on dorsiflexion to work, and those muscles and tendons aren’t the ones that got torn.

My first ATR (and surgery) were a couple of weeks earlier in the year, but this recovery has been MANY weeks quicker (so far), so I’m not expecting any problems this time, either — despite being a 64-year-old, with another birthday before that first race!! Time will tell, but So Far, So Good!

Hi Chocolata

My husband was flying back on 23rd December. He was fine, but other people on the flight were not permiited to board, so therefore didn’t make it to their destination for Christmas - how mad would you be!!

Re sounding like a child wanting a toy - well in my experience:
1. Those who shout loudest normally get the most attention
2. It’s your leg and if you don’t make a fuss, no-one else will (ok partners/family excepted)
3. If things turn to custard (sorry, NZ phrase probably = things go very wrong) in any department (flight etc) then you are the one who will be affected.
4. The worst they will think is that you are a bit of a nuisance for five minutes…after that they will move on to the next person.

Go for it!

Have a great weekend all. My kids a bit tearful tonight - took husband (Dad) to airport for his away for two weeks, and they have a tired and grumpy Mum instead.

PS I can carry plates and cups of coffee - I just whizz around on my typist chair - am getting quite fast now! (Though I nearly tipped myself down the stairs today, which wouldn’t have been so clever!)

Hi All,
It has been so interesting and enlightning to read about everyone elses experiences. It definitely makes you feel part of a “club”, albeit not one I would choose to join!
Norm, I read your blog and I felt heartened that in about 5 or 6 weeks , I could be walking in two shoes, cycling or driving! That doesn’t seem so long, considering I am nearly 7 weeks in! And I know exactly what you mean about the backpack that goes everywhere with me! Can’t wait to ditch that! Good luck with your aims for the next few months.
Chocolata, I too have read many papers on the benefits of early weight bearing…there are so many different approaches to this recovery aren’t there? I mentioned this fact to my consultant last time and he said that he couldn’t say which way was right or wrong, he just goes with his own beliefs. Only 5 more days till I my next appointment!
CoolKiwi, you made me laugh when you said that you nearly tipped yourself down the stairs on your chair! Please don’t do that!! What a story it would make!
Anyway, take care everyone and catch up soon.
Anne

Good luck with you appointment tomorrow Chocolata! Let us know how you get on. I am going at 11 am and really hoping for the boot! I’ll update tomorrow!

Anne

Well. I have my aircast boot and I am to start weightbearing straight away! It feels really strange to put any pressure on my foot but it is lovely to be able to walk, in a fashion! I am just using one crutch for balance and support at the moment but should be able to lose that after a couple of days. I can move my foot a bit and am rotating my ankle easily. Everything feels a little tight and I feel a bit of discomfort in my ankle when rocking forward on the boot. I guess all this is normal. I am starting physio next week and will go back to the clinic in two weeks for another check. I will keep you informed! How did you get on today Chocolata?

Anne, it’s great that you can already put a bunch of weight on that foot after it’s been hanging in the air for 7 weeks! Congrats! If your heel starts getting sore, I’d back off a bit, even back to 2 crutches for a while. You don’t want to get a real heel spur.

The key to walking in a boot like the Aircast without stressing your AT is to (a) make sure the upper straps on your boot are secure and not too loose. And (b) TRUST those straps! As you “rock” on the boot, from heel to toe, you push your knee forward, and the front of your shin takes all the “load” that your calf-and-AT would take, if they were strong and healthy.

Avoid “gimp-walking”, with your feet far apart. Keep it as normal as possible. And try to elevate your “good” foot somehow, so your body is straight when you’re boot-walking. I’ve posted ideas on how to do that. Somewhere!

If your foot (heel) can take the load, you should be walking pretty soon, pretty fast, and forgetting where you left that crutch!

If your shin gets sore from bearing all that load, you can pad it. As you get more comfy, you’ll naturally find your calf-and-AT “helping”, and getting some exercise. That’s where I prefer a hinged boot, so the calf-and-AT can push through a ROM, and not just in one place. Others switch to 2-shoes ASAP, which can be good exercise but is also scary-risky.

Thank you for the advice Norm! I love my boot! I have a real sense of freedom now! I can walk without crutches and it’s lovely to be able to carry things again! Yestrday I just kept picking things up and carrying them around just because I can! I only have a slight discomfort in my ankle at the moment. The doctor said that this is where the hard work begins! He reminded me that there is still a long way to go…but at the moment I am so thrilled at my new found mobility!
How are things with you?

Hilarious, Anne, thanks for the laugh! As I said above, becoming able to carry stuff around again is a real “smile”!

I’m doing pretty well, thanks. Saw my “Orthopedic non-surgeon” yesterday — don’t tell him I call him that, ’cause he’s a very fancy surgeon, he just didn’t operate on ME! — and my physio today. My foot seems puffier (more swollen) than it’s been, maybe because I’m exercising it, and maybe because I’ve gotten out of the habit of elevating all the time.

Surgeon suggested compression, with a stretchy ankle support. Not for protection against injury, just to squeeze the fluids out. I’m trying it, but I think it’s still puffy. Not uncomfortable and certainly not painful, but there it is.

The physio more-or-less OK’d me to do the exercises I’ve already started doing, including doug53’s slow eccentric lowering. My physio (like most) is into serious gym-rats, who don’t mind spending hours doing set after set of multiple reps of the same (boring) exercise, isolating one muscle at a time. BORING!

I know it’s good for me — like cod liver oil, but I have trouble getting out of the chair several times a day to actually do that sort of thing. But jogging in place, or dancing from foot to foot — or playing sports, of course! — those things are kind of fun.

Hi Norm,
How is the swelling now? Is the ankle support making a diffference? I have noticed puffiness around the ankle over the last couple of days…like you I presumed it is because I am actually using the leg and not elevating so much. Elevation does work very quickly to reduce this though.
I am hoping to start physio this week. I have been doing gentle ankle movements but it will be good to be given some official exercises. Like you though, I think I may find the motivation tricky after a while!
I have just found out that I can cycle wearing my boot and I have just been out for a cycle along the Thames tow path in the beautiful Spring sunshine! What an absolute delight! There is definitely a big light at the end of the long tunnel now! I’m free from being totally dependent on other people to get out! WHHHEEEEEEE!!!

Anne - That’s fantastic news!!!
I’m so glad for you. ;-)
I need to be in the cast for another 10 days and will get the AirCast boot - the beginning of my FWB!
Enjoy the lovely spring sunshine and your independence, Anne!

You will love the boot Chocolata! So much freedom! 10 days will whizz by and then you can join the booted brigade!

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