The Second Follow-up visit. Boots

Achilles Icon PWB

My second post-op visit to see the doctor was at about 4 weeks. The nurse took my cast off, and it felt great to let my leg breathe.
I knew that my calf muscle had been atrophying, but I was still surprised to see it so puny. The skin was loose around the muscle! So it looks like I have a lot of rehab ahead of me.

I saw the surgeon this time, and he cleared me to ditch the crutches and start walking in the CAM boot. When not walking, I can take the boot off and move the foot as much as I want. I can shower and finally wash the foot that hasn’t been washed in over a month.

I’ll be doing physical therapy at around 5 to 6 week mark. The scrip says:
“PT 2-3x week / 8 weeks,
ROM, Strengthening, modalities, evaluate & treat”

He said that I should do some exercises while I am home as well. Here is a good literature (pdf document) with illustrations for home exercises: Home Program For Ankle Exercises

He also mentioned that from what he recalls, my surgery was fairly routine and there wasn’t any other damage. He trimmed off the damaged ends, put sutures on both ends and tied them together. In addition, he wraps more absorbing sutures around the reattached tendon for added support.

He does 3 to 4 achilles tendon surgeries a month, and that’s the bulk of the ATR surgeries at that particular hospital.

So the follow-up was fairly brief, with minimal examination as I didn’t complain of any pain or other complications. In fact, I don’t even think he laid eyes on my heel, which I think is bizarre come to think of it.
But who knows, maybe it’s all like that.

After the surgeon left, an orthodist (sp?) came in and fitted me with a boot. She showed me how to put on and take off the boot, along with some helpful tips like: When indoors, wear an indoor shoe on the other foot so that it feels more level.

Here is what the boot looks like:

Air Walker Boot

I don’t see any model number on the boot, but looking at their website, I think it’s MaxTrax Air Walker made by DJ Ortho. It looks like they also make the Aircasts. Not sure why they brand them under two different names though. It has a single air pump in the front that inflates the air bladder in the padding for more support.

Some others on this site were fitted with half-length boots that come up to middle of your calf, not all the way up to just-below your knee. I’ve heard that it is better for lessening calf atrophy, but it doesn’t provide as much protection. Dave (http://achillesblog.com/daveleft) re-ruptured his achilles while wearing this type of boot. He was fitted with a full length (up to his knees) boot the second time around.

I don’t feel comfortable walking in the boot yet, but it’s better than fumbling with crutches. I limp around, but it should get better as I get more and more comfortable with bearing weight on my left foot.

So I drove home, parked the car in the garage, took my crutches out and put them in a dark corner. Hopefully I’ll never need them ever.

169 Responses to “The Second Follow-up visit. Boots”

  1. Michael,

    Is your toe pointed down in the cast, or fairly flat? How bad is your pain on a 1 - 10 scale?

    Are you staying in bed for a few days. or what are your plans? It’s going to be hard with thee kids running arond, although two are teenages, and one is 4! I am 54.

    Mike

  2. Mike -

    Right now, 26 hours post surgery I am pain free, 0. I am in a splint, top and bottom of foot extending halfway up my lower leg all held in place by what looks like 2 miles of Ace bandages. My foot is pointed down and only my toes can move. The doctor doesn’t use a cast at first so that it’s easier for him to check the incision. As you may know, the major potential complication for this surgery is infection. There is very limited blood flow to this area.

    I am 58, with a daughter in college and one teenage son at home. My wife is a trooper and has gotten used to my sports injuries. I landed in the hospital 4 years ago after a bicycling accident. 3 broken ribs, broken shoulder blade and a puctured lung. My bike helmet saved my life.

    I just came back from my first walk with the crutches. Walked a few blocks for about twenty minutes. Downhill is easier than uphill. All in all, it was a pretty good workout.

    Again, ggod luck and feel free to ask more questions. After all, I’m a 26 hour veteran.

    Michael

  3. My Dr. does casts only, or at least that is what he just said when I called I did call and request a splint.

    How is the swelling with your leg down on crutches? If I can get around without too much swelling I can actually live my life pretty well. I also have a trolley that someone let me use.

    Do you keep it elevated most of the day?

    Last question how was the pain compared to the accident, when it happened? Mine has been very mild but I do have a pretty high tolerance for pain.

    Mike R

  4. Mike R - sorry about your injury…you can check out my status report after during week one @ http://achillesblog.com/brendan/2008/03/07/

    The first 3 days post op is when I experienced the most pain (probably never higher than a 6)…I took vicodin for the first 4 days…and was off it by the 5th day. I also elevated pretty much all the time for 2 weeks straight. Now, in my 4th week post op, I can keep it down and there isn’t any throbbing. I think Doc Ross mentioned…slow and steady wins the race…and that is fitting for my first few weeks.

  5. Mike R -

    If you are going to be in a cast after surgery, just make sure to elevate your leg as much as you can (above the level of your heart). It gets quite uncomfortable if your ankle swells and your leg is in a cast. I spent about 70-80% of my time in bed the first two weeks. When not in bed, I was on my desk slouching and making sure that my leg was elevated above the level of my heart.

    I couldn’t be on crutches for too long, as my foot started to turn puple.. When I laid down, it turned to normal color.

  6. i have a question to all of you
    my 2nd post op is in 2 weeks and my surgeon gave me the option of putting my foot/leg into a boot or an aircast
    has someone tried both?
    which one would you recommend?
    is one lighter than the other?
    thanks

  7. Nancy - I was in a splint for 2 weeks, a cast for 1 week, and an Aircast for 2 weeks after that, all NWB. Then after 5 weeks I’m 50% WB in the Aircast. I have not tried a boot. I think the Aircast is good…seems relatively light. Maybe they could show you both so you could compare on the spot and make a decision? Not sure of the pros and cons.

    John

  8. Nancy - here’s a discussion on another forum: http://www.marfell.me.uk/nuke/modules.php?name=Forums&file=viewtopic&t=705

  9. thanks guys
    my friend lent me her aircast so i’ll try it
    and maybe try the boot at the hospital if they have one so i compare
    thanks for the link brendan, i’ve been reading for at least one hour
    i think i’ve never read so much in my life
    same thing for using my laptop
    it’s going to be hard to go back to work without checking this site!

  10. Advice on slight movements - Hey! Dr. said while I “air” out the incision area once a day while my splint is off he wants me to move foot “slightly.” I don’t want to overdue it, but I also want to make sure I’m moving it enought to benefit. I’m 2 weeks post op. Advice on movement pls? thx!

  11. Kristen - At 2 weeks I would keep the movements to a minimum. Flex your foot down a bit until you feel resistance, hold for a couple of seconds and then flex your foot up and hold for a couple of seconds. You could also try the same with lateral movements. The movements should be slow and controlled, just enough movement to keep the ankle from getting too stiff while it is immobile. If you feel pain when doing the movements, you’re probably doing too much. This advice is just from my experience and not medically based, so take at your own risk. Perhaps Doc Ross may have more information.

  12. Kristin..

    I agree with Tom…start some range of motion, a good idea would be the alphabet exercise. Spell each letter of the alphabet as though your big toe was the pen. this will give you a finite amount of time doing something and take you through all the motions. Remember no sharp pain you should feel some mild pulling/strectching. Slow and steady wins the race with this injury.

    Let me know if you have any more questions.

    Doc Ross

  13. I am 4 weeks post-op and just got into my Cam Walker boot….I am 33/m in good physical condition. Does anyone know how long it takes to be full weight bearing in the boot so I can get off the crutches? The heel seems to be the most sore of anywhere. I am only supposed to be in the boot 2 weeks before I start PT. Thanks,

    Brent

  14. Brent Galyon -

    It really depends on your doctor’s protocol. There is really no set time. As you can see from everyone’s experiences, it really varies. Good luck with your recovery, and keep us posted.

  15. Hi all - I am 3 weeks post-surgery and just found this site! Total rupture - tendon retrenched way up in to the calf - 5″ incision, etc.

    I have been casted in inflection (toes down) since surgery and see the doc next Thirsday. At the last visit (one week post-op) he mentioned he would be recasting me in “neutral” position for another 2-3 weeks. I am going nuts with the non-weight bearing thing and want to talk the doc into putting me in a boot. Anyone out there have to “negotiate” this with the doctor? Any ammunition I can use?

    Ed

  16. HI all - just discovered site, so still need to put info on blog, but since I just had my 2nd follow-up yesterday, I thought I would chime in. I was playing in a tennis tournament out of town Memorial weekend when this happened. *When I get the chance, I’ll read how other’s injuries happened - I’m curious how many are NOT sports related based on what I’ve been hearing.

    My doc took the original 2 wk old cast off, removed the staples and put me in a new fiberglass cast. From what he’s saying, I expect to be in a cast for 3 months(!!!) which seems a bit long compared to the other things I’m reading. He also did the long arched cut rather than orthoscopic surgery, which according to him allows for a better repair.

    So, I’m a bit concerned about atrophy with it being so fixed for such a long time, but he said he’s never had one he’s repaired break again.

    As of yesterday, he’s approved a light weight load on it, such as standing or balancing, but no walking on it, yet. My next appointment is in 4 wks.

    This looks like a great resource, so glad to see you all here. :)

    Sheila

  17. Sheila,
    sorry to hear about our injury. I did mine playing tennis too. Warmed up after a tough first set then pow after coming in behind a serve. Happened in mid March. After you read what is on the blogs I think you will find that 3 months in the cast is very long. I was in 3 weeks and then in a boot - NWB and crutches for a few weeks. After 3 months was doing great, almost walking normal then slipped a little coming up the stairs and did it again above where he repaired it. I am now almost a month past the second surgery and looking to get out of the cast soon - at least by 7-10. Read up what others have done and make your decision. The longer in the cast, the longer your recovery will be.

  18. Has anyone re-injured the achilles tendon during the post op recovery time? I am at 7 weeks post op and was put in an orthopedic “sock” yesterday. Today I turned the microwave oven on and it immediately made an explosive sound — sounded like a gunshot. I must have moved backward suddenly. The surgery site hurt badly and a raised area developed and turned blueish. I am so worried that I will have to have surgery again. My initial injury was from a bottle breaking and a piece of glass sliced my tendon in half.

  19. Hey Catherine, Daveleft and Chipintn are both re-ruptures. Check out their blogs. I suggest calling your surgeon and scheduling an appt., so you can find out where you are. Though I’m not a doctor, if you can move your foot around, you are probably ok.

  20. I’m 3 days in after total rupture being treated non surgically. Totally depressed and struggling with the enormity of the recovery period

  21. I just discovered this blog searching for more information on how long it takes for a completely ruptured achilles tendon to grow scar tissue after surgery. I had a complete rupture of my rt. AT on June 29th playing frisbee. I heard a “pop” and felt like a hardball had hit my calf! My son in law who is a cardiologist almost immediately diagnosed my injury as a ruptured AT. I had surgery on July 3rd, was fitted with a plaster splint for 13 days and am currently 18 days post op. I was fitted with a Aircast pneumatic boot on Day 13 post op. When I was examined at Day 13, my surgeon informed me that he did plastic surgery on my incision. It looked very nice. I have been incrementally putting more weight on my boot walking around my condo with a single crutch. My son in law said it would take around six weeks for the repaired tendon to “scar” over but cautioned me to be patient with PT, etc. I am 64, and in good physical condition and a very good immune system. At least thats what I have been told. (I recovered form a broken ankle (compound fracture) in three weeks.) I am hoping that this will speed up my recovery. Like others, I have experienced a slight heel pain when walking around in the Aircast boot. I am particularly frustrated because I just bought a new Nissan 350Z convertible, 6 speed, 306 HP….and its just sitting there waiting to get a ticket! BTW, I stopped taking percocet (750 mg) on Day 10 due to no pain whatsoever. Good luck to everyone on a speedy and complete AT recovery!!

  22. i am 5 weeks post op and im still in a hardcast.

    im going in for my 2nd post op tomorrow.

    will i get a boot?!

    surgeon said that my full rupture was the worst he has ever seen and said he was going to cast me for 3 months total.

    is this possible?!

    my leg feels strong and good. i can feel that it is healing very well and i could bear weight on it if i wanted (although I am not)

    if he puts me in a cast for another 1-2 months he might as well cut my leg off.

  23. Peter,
    By ’surgeon’ I assume that you did have surgery and not a non surgical. I am no doctor so therefore I can only speak from personal experience with my injury so here I go…..

    12 weeks-WAY too long
    If you check out my page you’ll see why I say that. Blood clots are a huge risk at 5 weeks, much less 3 months. My surgeon favors early weight bearing but said I splintered my tendon very bad so he had me in a cast for 5 weeks. Unless he is not confident in his repair I can’t see 12 weeks making any sense. Maybe he plans to put you at PWB in the next cast. That is possible. Not everyone gets a boot. Some get a walking cast.
    Also, you may think your leg is stron but wait until you see it out of the csat….not so much. If you went 12 weeks NWB it would be extremely weak.
    Talk to him about your concerns. I have learned that you have to demand that few extra minutes to get your questions answered.
    Either way, I wish you luck and if you do end up back in the cast talk to him about clots. Tell him you think you are ready.
    Be your best advocate.
    Matt

  24. yes it was a surgery.

    i didnt mean i think my leg is strong, because i know its a toothpick.

    at the 2 week visit he took me out of the hardcast to remove the sutures, and re applied a new hardcast, so i know what it looks like and how weak it is.

    i just meant, before surgery and after injury, i couldnt even move my toes or my foot down in any way, now, 5 weeks after surgery (albeit in a hard cast), i can point my foot down, flex my calf muscle, and point my toes down (to the extent the cast allows me)

    i just meant my new tendon feels strong and fairly well healed.

    appointment is in 10 hours ill try to post when i return.

    thanks for the info about blood clots.

  25. Hello Peter,
    I’m nearly 10 weeks in a hard cast because the doc was not happy with healing after 7 weeks so ordered 3 extra. I’m back to the hosp next Monday hopefully for better news. It was a setback when he told me but it seems to me its long term whichever route tour Dr prefers

    Take care

    Richard

  26. well i just got back from the dr and he did some resistance tests and was surprised @ how well i am healing, but he wants me in this cast for another week

    then he said he was either going to put me in a boot or another hard cast with my foot straight, or something.

    im really getting frustrated with this, which is odd because i have had so many sports injuries in the past and been in casts so many times you would think id be used to it.

    oh well i guess ill report next week

  27. Peter,
    Take some time and read some of the hundreds of stories on this site - yes its frustrating and loads of people think ttheir Drs could be doing things differently but the common theme running through everybodys story is that there’s no short cut. You might complain and get in a boot 2 weeks before anyone else but all that does is put you at more risk of a re-rupture - How would you feel then?
    Cheers
    Richard

  28. So, I went back to the doctor today for my visit.

    He took me out of the hard cast, and thought to himself for a good 2-3 minutes. It felt like hours, and I was just praying, boot, boot, boot!

    Finally, he decided to put me in a new hard cast for two more weeks, at which point he is going to put me into a walking boot! At first he was talking about some sort of heal lift, but then decided on a walking boot.

    He moved my foot to its normal position as opposed to toe pointing down. He said I could put some weight on the hard cast if I wanted, but every time I do, I have some pain in my heal (not my achilles, feels like the bones). Does anyone know if this is because there are essentially no muscles in my leg anymore?

    Also, he told me to come to my next appointment with the walking boot, or he wont take me out of the cast.

    I have no medical insurance and I have had to pay for this whole ordeal myself, which as you all know, is costing in excess of 10 grand.

    Does anyone know where I can find a CHEAP walking boot? I am a size 13. I have seen them for between $100-$200, but I really want to keep cost down as much as possible.

    If anyone has a used one to sell, I would be more than happy to buy it!

    If not, does anyone know where I can buy a cheap one or even a used one?

    Thanks in advance for the answers and support!

    - Peter

    ptrontheirc@yahoo.com

  29. First of all, this site is great…it has been very informative for me and this is my first post. I had surgery on 9/11 and wore soft cast for 1 week, a hard cast for 2 weeks and went to the Dr today (Oct 1) and he told me I could ditch my crutches if comfortable, but did have me testing full weight bearing in a boot today…which I can do. I am not really comfortable without crutches yet, so I anticipate dropping 1 crutch in a week and both soon thereafter. Maybe in 2 weeks. I started PT today too with some very minor ankle ROM exercises, but I am to do them daily and go to PT 2-3 times per week. I had a complete tear playing volleyball Labor Day weekend. I do not understand why any patient is being kept in their hard cast by their doctor for longer than 3-5 weeks. I will be in my walking boot for 6 more weeks and then, if all goes well, PLEASE G-D!!!, will be in 2 shoes and driving again. I have done everything the
    Dr. said and plan on using extreme caution now that I am in a boot. I do not want surgery again….no way….no how! So, please feel free to ask questions, but if you search long and hard enough, all the answers seem to be on this site. Good luck everyone!

  30. Good evening all — I torn my tendon on 12 July playing basketball with my son and had surgery on 21 July . It was a clean tear - to the best of my knowlege. Like a lot of other folks, I was in a soft cast for little over 2 weeks after surgery — can’t stress the importance of keeping the foot elevated; I think it had a significant impact on my recovery. Hated the meds but I only experienced true “pain” the night of the surgery. It got a little boring and just getting to the kitchen for food was quite a chore. The NWB cast was a little cumbersome; hated the crutches with a passion. I used a trash bag, rubber bands and athletic tape to take showers; I got pretty comfortable with that method and had no issue with “wet cast”. The walking cast was a welcome relief, but even that got tiring, literally and figuratively. I was in the walking cast for about 3 weeks and I’ve been in a boot for the last 3 weeks. Nothing better than that first shower without the cast!! I’m cleared to ditch the boot 21 Oct, exactly 3 months after the surgery. I’ve already got a pretty good range of motion and may get to forego formal rehab and do it on my own. The only dissapointing issue is I’ve been asked by the doc to avoid high impact sports for about 3 months - That puts me out of commission until January 09. Unfortunately, the doc also told me not to play golf during that time (my sport of choice); the torque on my left leg could slow down healing and possibly re-tear. Frustrating to be sure, but as many others have said, its worth it - I definitely don’t want to go through this again. Great surgeon, and by the grace of God, little if any pain throughout the whole process thus far. Best advice I can give is if you have the option, have the surgery, bite the bullet and get the tendon healed. Above all, be patient!! Take care and God bless — ken

  31. Every person coming to this blog should positively, absolutely look at a cast boot called VACOPED. The website is http://www.vacoped.com. It can be used from the day of surgery instead of a cast and allows physical therapy as early as your doctor will allow. it is a tall boot (just below the knee but has a soft flap that allows the calf to move. So atrophy and ankle stiffness are much reduced compared with casting followed by a camboot. it is the only boot designed specifically for achilles ruptures and is head and shoulders better than all alternatives. It is from Germany where they are far more innovative than here, and the healthcare system is designed so that high quality boots get dispensed by doctors. Here the docs get more profit by dispensing low quality, inexpensive boots. So, you will have to demand VACOPED from your doc because he will probably want to give you something cheap.

  32. Check out what this crazy guy did in his achilles boot… http://www.youtube.com/watch?v=Z6vxFuvY4kk

  33. Matthew, many thanks for the information on VACOped. I have been looking for a good boot to purchase and I think I’ll get a VACO achill. Also, that YouTube video was good.

    7 weeks out of surgery, I’m starting to bear some weights. Could have done it earlier, but I fell down on a wet floor 2 weeks after surgery and aggravated my foot a bit although I was wearing a plaster at the time. So, we decided to be more cautious.

    Thanks again and take care. ~Dorj

  34. I am 42 yr male living Brunei which is on the island of Borneo. I had my ruptured AT surgically repaired on December 09 by a visting surgeon from England. I was in hard cast for 12 days and then I was fitted with the only cam boot on the island of Borneo. It is very old and the lining was falling apart. I guess not too many of these injuries here in Brunei. I have only been in the boot for 9 nine days but I can already put some weight on my repaired AT. The strange thing is that I have never had any pain to speak of. I never took any pain pills at all. I can even put full weight on my leg when I take the boot off to take a shower. I am sure I should not be doing this but the doctor neve rgave me any orders. Does anyone know if I am doing any damage that I might not realize? I am even taking the boot off at night to sleep. The only concern I have is swelling. Its been 3 weeks today since my suregery and by bedtime my foot is very swollen but It’s close to normal by the next morning. I will go back to see the resident surgeon on Jan 10. I hope I am not doing anything that could pro-long the rehab time.

  35. Hi Darryl,

    I do not think you should be putting so much weight on your leg just yet, even though you have no pain. I didn’t have much in the way of pain but I had my leg in plaster for 10 weeks with a ‘non weight bearing’ instruction from my surgeon. Was your surgeon just visisiting the Island or was he there on a voluntary basis to do operations? What was his name, I can check him out over here in England for you if necessary.

    The swelling is normal so no need to worry about that it can be quite a while before that settles down.

    Good luck with your healing
    Annie

  36. I have just had a boot fitted after six weeks in plaster and am wondering whether my expeireince of pain is unusual. My heel refused to go to the bottom of the boot (it has a 30cm heel lift in it) when it was being fitted as I resisted due to very sharp pain. Two days later my heel is in place but I have constant pain in my achilles feels like more than stretching-type pain. Foot is swollen although not enormously, I have read lots of experieinces of pain in the heel when first wearing the boot but not the achilles. I am worried it might have re-ruptured?
    Anyone had a simlar experience?

  37. I’ve just ruptured my achilles tendon and am exactly 1 week post-surgery. I’ve read everyone’s experience and there is such a wide range on when folks are able to get out of plaster and into a boot. It seems like the sooner you can get into a boot the better your recovery.

    My doctor said I’d have to go 4 weeks in a cast, but I want to get out in 3 so I can start rehab. I play competitive football and can’t afford 6 weeks of muscle astrophy.

    Any advice? What types of therapy can I do while in a cast to facilitate the healing process?

  38. Hi Georgie,

    I was also in various casts for a period of 6 weeks post-op. I was given a boot (with one gel-like heal) for a period of about 1 week after my casts. I was told that I only needed to use the boot when weight-bearing. Initially, I eperienced pain/discomfort when placing my foot in the boot, this was mainly due to the tendon stretching. I also noticed that my ankle (not so much the tendon) would get swollen towards the end of the day. Elevation and ice helped with swelling/discomfort. I would recommend phsyiotherapy as soon as possible as they managed to massage/loosen/stretch the tendon to make it feel more confortable. Physio will also loosen your calf muscles and get you working on dormant muscles. You are unlikely to have re-ruptured if you have been NWB in casts for 6 weeks. If you are very concerned about re-rupture then you should speak to your consultant. Hope it all goes well for you.

  39. hi everyone,

    I have mixed feelings about sharing my experience because for whatever reason my recovery seems to have been easier and faster than the accounts that I am reading. But I hope this makes more people feel better than worse.

    My first follow-up after surgery was at 1 week. My surgeon cut off the the fiberglass splint and looked at the surgery site. He did not remove stitches because apparently the ones he used are dissolving. Then I waited for a rep to fit me with an orthopedic boot.

    My surgeon recommended 2 cushions, which felt OK (a slight stretching of my tendon) when I put it on. But by the time I got home, it felt like a little too much stretching with any weight bearing, so I put a 3rd cushion back in.

    I should explain that I am a mechanical engineer, and while I was being fitted I looked at the boot and asked questions to understand how it works. I have since adjusted the various velcro straps until there was no pressure on the surgery site. I also found that when strapping into the boot, it is key to push hard (if no pain of course), so my leg is in the same position as when I am bearing weight. Otherwise the movement pulls on my skin and hurts.

    Today, only 8 days after surgery, I can walk as far as 10-15 feet in my boot without crutches(!) There is no pain (otherwise I wouldn’t do it). I don’t go further because it still feels uncomfortable to have my foot not elevated and I don’t want to push my luck. Otherwise, I am getting around with one crutch on the same side as my good leg. :-)

  40. Thanks Rudedog
    - and will090425 - it is very helpful to hear others’ experiences. I think I am possibly just being over-stretched in this boot as the pain just doesn’t go away until I take it off. I have never considered myself particularly wimpy when it comes to pain but who knows?

  41. Hi Georgie,

    It sounds like your achilles tendon is being stretched too far. I had the same feeling, but less severe, and that is why I put back an extra 10 deg cushion in my heel. My surgeon said “two cushions” without actually measuring the angle and the rep who fitted me kept asking _me_ how it felt.

    So I am pretty sure you are the best judge of what feels right, and you are reporting that it hurts and feels like it is stretching too much. Can you figure out how to adjust your boot to get some relief?

    When I am strapped in, I can actually lift my toes off the front, demonstrating that I am not stressing the tendon.

  42. I think you’re right will090425. I got so worried about new pain and bruising that I have had it checked out again with an ultrasound. According to the professionals all is well and it is healing nicely. I feel like a bit of a panicker now but I am also very glad I am not still wondering if it has re-ruptured. And finally, six days after the boot was fitted, I can get in and out of it without pain. I have another week before the heel is lowered further and I think I might try and get some massage therapy before then.
    Good luck with yours!

  43. First of all, many thanks to the originator of this blog and to all those who have contributed!!

    I, like will90245, have had a very easy time in my recovery. Sometimes so easy and comfortable that I fear I may not be doing something correctly.

    I am 55 y/o and had a complete rupture while playing BB. I did hear a slight “pop” when I pushed off my right leg and felt pain for about 15 sec. I iced it right away and drove home (using right foot). I limped around the next 2 weeks thinking that I had only sprained something as there was no immense pain and I still have some ROM in my foot/ankle.

    After 2 weeks of no improvement (more swelling), I visited the orthpedic doctor. He tested, did MRI and determined complete tendon rupture. Had suregery the following day.

    For 2 weeks I had the splint and bandages (NWB) with crutches. At 1st post-op, doctor removed and put me in a MaxTrax Air WalkerCAM boot and told me NWB for 2 months, but at night to remove the boot and do simple ROM exercises.

    Currently, I am at 3.5 weeks post-op and I have excellent ROM and I actually (don’t tell my doc) have FWB while walking in the boot (and when I take it off at night). No pain or discomfort at all. When I do the ROM exercises, I do feel a slight strain on the tendon which is expected.

    Like I said, this seems too quick and easy based on what I’ve read. However, I have found many places (two web addresses published below) that promot walkingand exercises as soon as possible after suregery. This actually promotes a faster, more robust recovery.

    http://footandankle.mdmercy.com/conditions/achilles_tendon_probs/acute_achl_tendonrupture.html

    http://www.med.umich.edu/ortho/patient/PDF/ACHILLES-TENDON-Rupture%20.pdf

    Hope this is helpful

  44. 14 weeks out from surgery. Any one did this with not having PT ordered up??

  45. Im in the 5th week of the boot (of 8) and have suddenly developed very sharp pins n needles sensation on the ball of my foot. Im pretty sure its the skin getting nasty under there as Im never allowed to take the boot off (nope not for sleeping/showering!!).

    A quick call to my therapist confirmed this. Its a little frustrating as I was walking around in the boot last week and now its too painful to put the boot down so am back on crutches/resting the boot.

    Its sore and not a very pleasant feeling. Anyone else had a similar experience?

  46. I was told that I could take off the boot for showering but wear it all the time otherwise. By the the time I had it on two weeks I was cheating and not sleeping with it either. I assume you should wear it sleeping just to protect it from getting the foot wrenched the wrong way or falling out of bed ? Anyway, I turned out fine.

  47. Well, am taking it slower after my scare, but was wondering whether should take the last wedge out, as its been 2 and a half weeks since removing the second one. Still not walking without frame but foot more comfortable. Any opinions on how frequently at what rate to remove wedges?
    Ta

  48. Linda - My wedges have been removed at two weekly intervals but not by me, Ive had to go and see occupational therapist who cleans the boot/removes wedge etc…so best to check with whos managing your foot…

  49. I hadn’t played kickball in years. I tore mine running from 3rd base home and then to the bench - 5 minutes of pain level 5 then very little pain. I had a surgeon cut me and sew it all up 6 days later. The pain was about level 6 the first day but then it subsided to no need for pain killers within 3-4 days. The biggest stress has been figuring out how to live alone with this ordeal. The second biggest challenge has been permanent ice cover around here on crutches - I feel like I risk landing in the nursing home every time I have to go out. After a week in the 1st cast NWB , I fell while trying to hang up a sign requesting grocery delivery to put everything on my counters inside rather than outside on the ground. After the fall it smarted quite a bit (level 5 for 1/2 hour) and I was very, very worried. The doc assured me that the cast held everything in place. On day 10 or so I had that cast and the staples removed and the doctor put on NWB cast #2 for 20 more days. It was fairly comfortable and I was getting around fairly well on my knee walker with steering which I cannot recommend strongly enough especially after the surgery. After that cast was removed, the doctor put on the moon boot and told me to bear up to 50% weight as tolerated. After 3 days of the moonboot, I can only bear about 5-10% weight without some pain which I interpret as a signal that that’s enough weight. I got rid of the knee walker because it isn’t compatible with bearing weight so this week has been a setback. My level of disability has increased to the same level as about a week after surgery. Week 5 will be over tomorrow. Should I put more weight on it? My heel is about 1 1/2 inches from the bottom of the boot which concerns me - should I adjust the cam so that the gap is a lot less and try to go down a little bit at a time rather than leave a 1.5″ gap? I have always been as stiff as a board which the doctor confirmed after surgery and wonder if it will make stretching the tendon out a challenge. The doc says that within 10 days I am supposed to be walking around FWB in the moonboot. I’ll continue working on weight bearing but am a bit dubious. Should I push up the pain level or interpret the pins and needles and pain as meaning that I need a bit more time before bearing more weight? I’m hoping to ask the doctor tomorrow. It would be interesting to know what some of you went through when transitioning to weight bearing. I have read it was relatively easy for some people. Were there some of you out there that had a hard time? Tks

  50. Hi Phil,
    I have been in cast for 5 weeks after surgery, and then in the boot at 30 degrees angle for a week before trying full weight bearing and 0 degrees. The pins and needles feeling in the sole of the foot is not much concern I think, it is to be expected. However if you are stiff and your heel is 1 1/2 inch from the bottom of the boot that does not sound good to me. Transition should be gradual. You did not get wedges in the boot? I would think that with wedges (or adjustable angle) in the boot with gradual weight bearing the tendon could stretch gradually. But putting full weight on it when your heel is not touching the bottom is not possible in my opinion, that is like walking on tip toe that engages strongly the calf muscles and stresses the tendon.
    Managing alone with this injury must be particularly hard. Do not be ashamed to ask for help.

  51. Thank you for your response. Recently I figured out my doctor installed my boot incorrectly. My heel was suspended 1 1/2″ above the boot bed of the footbed of the boot by 2 strong hidden velcro straps which prevented my heel from seating in the boot.

    It happened because the boot was from another doctor and my doctor decided to use it to avoid having to buy another boot. When I brought it in, he said he wouldn’t need the instructions and cast them aside.

    Before I figured out the problem, things seemed a bit odd last week so I called a few times last week. The doc did not call back (it’s not billable time for him). I discovered the problem last night and got on the phone like a fly on feces this morning to explain things and learn that I needed to take the boot off and put it back on correctly.

    Due to being suspended in mid air, I do have some foot pain but have a hunch it will go away since I hadn’t born that much weight on it yet. The foot is painful to the touch in spots but not under weight.

    Everything feels a bit better and my weight bearing has gone up to the point where I now agree with the doc’s idea that I can start working on transitioning to full weight bearing in a week or so. I’m right now starting week 6.

  52. NWB, PWB, FWB Dates.

    Why is there such a range of the amount of time for each of these periods?

    Does it have to do with the specifics of one’s injury?

    Or does it have to do with the idea that medicine is a practice and that each doctor learned and follows a different method.

    I wonder if no one has actually figured out the minimal time for the NWB and PWB periods. There are some studies with very short NWB and PWB time frames, however, I believe they are typically too small to be conclusive, especially about the risk of rerupture if one does too much too soon.

    I’d enjoy reading what others know about this. Tks, P

  53. There are mysteries in the different rates of recovery.
    Having been through this twice, my experience with transitioning to full weight bearing was 2 different situations: first time conservative treatment, 3 casts for 7 weeks, and when I got the boot he put it at 0 degrees right away, and I could full weight bear a day later no problem. 2nd time after surgery I was in cast for 5 weeks, then the boot was set at 30 degrees for a week, and 0 degrees afterwards and was told to transition to weight bearing. I did not like the change so fast, so I set my boot back to 10 degrees for a few days, and to 0 after. But I took 2 weeks to be able to fully weight bear. I had pain around the ball of my foot felt like my middle toe was broken. Still it is sensitive. Why ? I did not get an answer. Sometimes I wonder if someone accidentally sat on my foot in surgery, or dropped it when flipping me around…? :-(

  54. Philip- I think that in addition to the preferences of docs and PTs, each of us and our differences are a huge reason for the range of time for each phase of recovery. We all have different intervals between injury and diagnosis as well as between diagnosis and surgery (or casting). Additionally, we’re all of different ages and levels of fitness. Given just these variables, it does not surprise me in the least that there is a wide difference in the amount of time that we spend in a certain phase.

  55. hi im done with the regular cast after having one for 3 months. now i have a camwalker starting today and i realized it is very hard for me to get the first step because it seems the mind is set to where it has to protect my foot. are there any good ways or tips on using the camwalker or does it just need practice?

  56. I used one crutch on the opposite side when I first started walking in the boot. I moved the boot foot and the crutch on the opposite side forward at the same time. Pretty soon I felt brave enough to lose the crutch most of the time, but still used it when I got really tired. For me it was more gradual than all of a sudden. Good luck, be brave!

  57. Tore my achilles in May 2009 and had surgery the first week of June. Surgery went as planned and so on. Started having problems after months of PT (5 months post surgery) so my Dr. sent me for an MRI and discovered another tear. He said it was lateral. I am now back in the boot waiting for my next appt to determine if I need a second surgery to remove scar tissue or whatever to solve this problem. This has been life changing for me. I’m an active person and this has really slowed me down.

  58. 42 year old male, tore my right achilles on 12/22 playing basketball; someone landed on the back of my leg as I was on the way down with a rebound. Had surgery 12/23. I was put in a splint for the first two weeks, then a walking boot for the next four, though I was told to bear no weight until the 6 week mark. Had to sleep with the boot on, which was pretty uncomfortable.There were two cushions in the heel; I was told to remove one of them at the four week mark. Today made 6 weeks since the surgery, and my orthopedist told me to ditch the boot and the crutches and walk unassisted, and gave me a script for PT 3x a week. I was apprehensive to put any weight on the leg, but once I did it felt better than I thought it would. Everything is stiff, and the calf is very weak, but I’m getting around better than expected. My only concern right now is that I’m experiencing a decent amount of heel pain when I walk, was wondering whether this is to be expected.

  59. Hi, Mick. Unfortunately, that kind of dull ache in the heel is pretty common based on my experience and what of read on many other blogs on here. I know in my case I exacerbate it by spending too much time on my feet and not enough time icing and elevating. You’re doing great. Get better every day!

  60. Mick, mine wasn’t a dull ache, more like “a decent amount of heel pain”. I think pain or discomfort under the heel is quite common. In my case, it was sometimes tingles (almost like electric shocks) and sometimes pain, like a heel spur or plantar fasciitis (are they the same?).

    And for me it got worse when I started taking out heel lifts (inside a fixed boot). I couldn’t tell how much was from the more neutral position and how much was from removing those soft cushy foam heel lifts, which were cushioning the impact of my heel strikes when I walked with the big clunky boot. So I put in a few different versions of soft full-foot foam pads.

    I tried the footbed from my ski boot, but I didn’t like it. Now I’m using a slab of cheap “ensolite” camping-pad foam, plus a very thin translucent gel heel pad (from the dollar store!) under my heel. (It’s maybe 1/8″ thick max, so I’m not worried about the effect on my flex angle.)

    One of the tips on one of the other Achilles blogs (hosted by a family, maybe in UK) suggests using a soft footbed when removing heel lifts, for just this reason. Among other things, your heel hasn’t borne any weight for 6 weeks, so it’s a “new thing” again.

    Another tip from my physio: He thought it probably was a mild case of plantar fasciitis, and recommended gently rolling my barefoot heel over a golf ball — like having somebody massage the “walnuts” out of a stiff or tense back. I tried that a bit. Not sure if it helped, but it didn’t hurt.

  61. One other thing, Mick: Some people here have added heel lifts when going to 2 shoes, then they gradually remove them. That’s not in my protocol, but it may help.

    In my fixed boot (no surgery this time), I started off with 3cm heel lift (by accident, protocol says 2cm), then I went to 2cm for a few days, then 1cm, and now ~0. Each lift-removal was “a stretch” except for the last, which actually felt BETTER than before(!).

    Now I’m in a hinged boot at 8 weeks, hinged from 0=neutral to way toe-down — 25 or 40 degrees, about as far as I can extend anyway. Protocol says “wean off boot” now, but I’m thinking of staying hinged for a while, gradually shifting the adjustable pin from 0 to 5 then 10 degrees toe-up (dorsiflexion) instead of jumping straight to 2 shoes.

  62. Hi, I’ll start to use the boot in my right leg since the next week, so I would like to know if I can drive my car to work, Is that possible with that boot?

  63. Somebody posted here that it’s actually illegal to drive in a cast or boot where they live. I’ve been driving without interruption since my latest (2nd) ATR, but this was my LEFT leg, and our new car is an automatic, so the boot just sits to the side.

    8 yrs ago, when I tore my right AT, I drove (stick shift) between the tear and the surgery (putting my right HEEL on the pedal, gas and brake!). I don’t think I drove again ’til I was in two shoes, but I may be forgetting a few car trips in the boot.

    Heck, if your boot catches the gas pedal when you’re applying the brake, you’ll be simulating the (admittedly extremely rare) Toyota experience! ;o)

  64. I am 12 days from surgery for torn achilles and got a cast on day 8. Since getting the cast fitted, I have had much pain on the side of my foot near the heel and it is waking me up at night. The sore spot is not near the surgery area. I had the doctor check it and he said the cast was causing it. He took off the cast 24 hrs ago and refitted me with another but the pain on the side has not subsided. The doctor did not change the wrap under the cast and wondering if that might be the cause of the pain if it is wrapped too tightly.

    Hoping the pain susides today or will have to go back again to doctor. Has anyone else had experience with this kind of discomfort ?

    My surgical area is sensitive to touch but not causing much pain.

  65. Hello Mccue, had the same problem myself with the splint (doc had placed a splint that covered my foot and calf and then wrapped the whole leg up until my knee) on the second week after a visited him and I thought he misplaced it. It felt like I was standing on a rock for hours with my heel! So, I woke up at night and my husband helped me unwrapped it and loosen it a bit. I didn’t have to go to see him, when I told him about it, he said I did well. Go unwrap it and place the splint where you feel good, then wrap it again but not too tight.

  66. Hello everyone, This is one club I’d rather not be apart of but since we are all in the same “boot” I’m honored. Had the injury February 1st, surgery on February 17th, first follow up on March first and here I am today. We all have so much in common. The greatest atribute we all share is the worthless misery. And I know I’m in great company. I have no clue what the next few months have in store for me but I know they will continue to suck, and slowly suck less and less. I will share with you my only secret for mental and physical treatment. Any help with this product would be welcomed. The product is a grain mixture of 70% corn, with the remainder being wheat and/or rye, and malted barley. This mixture, is called the sour mash fermentation in which mash from a previous distillation is added to ensure a consistent pH across batches. The fermented mash is then distilled to 80% alcohol. And the doctor says put it on ice. See ya in Rehab.

  67. Evening all. I just found this site today looking for recovery info and everyone has been particularly helpful. I tore mine playing soccer. Hadn’t played since college (32/m) but play hockey and golf regularly and stretched before playing, so I’m not a couch potato. Pain has gone away for the most part, however lots of discomfort from keeping it elevated, and then pressure/pins and needles in my calf, shin and foot arch. Wondering how normal this is. Apparently my tear was much longer than expected upon surgery, which is why I had pain all the way up to my calf. I’m guessing this is worse? My wife talked to my doc post-op, so I’m not completely clear on the details. 1st post op exam in 2 days. Any help would be appreciated.

  68. Probably what the doctor said was that it was higher, more toward the calf. There isn’t much in the way of nerves in the tendon itself but there plenty of nerves in the calf. The elevation is crucial as is applying ice packs the area around the repair. The skin around the ankle is tight and thin and if you don’t keep the swelling under control you can have problems with the incision not wanting to stay closed, which is what happened to me. Believe me, you don’t want to go there. I don’t understand pressure in your calf. Are you having muscle spasms in the calf? I’ve had four surgeries as a result of my ATR and had muscle spasms in my calf after each of the first three and they were really painful. If it’s actually muscle spasms, ask your doctor for a really strong muscle relaxant like Valium. That’s what I used and I was able to sleep through the night. Make a list of questions for your doctor and make sure he/she answers every one to your satisfaction.

    And get your own blog here as this particular spot isn’t very good for posting details.

    Good luck.

  69. I’m due for my 2nd follow up this coming Wednesday during which I will be put in a re-aligned cast that will enable me to walk after 5 weeks NWB. The week after however, I’m going on holiday with friends and family for a total of 3 weeks and 3 days which will overlap the proposed 8 weeks in plaster by my surgeon. I would ideally rather not travel with a cast, for various reasons including swelling on the flight, the heat and the fact that I would love to be able to go in the pool for a bit! I’d preferably travel with a brace or heel inserts as my hospital does not offer the boot, is this too soon to be out of the cast? I don’t know if I’m pushing it and would really like to have an informed perspective before presenting my case to my surgeon!

    PS. I don’t know how to make blog entries! I’ve set up my profile but I can’t seem to find where I can create new blog posts! Can anyone help? Thanks!

  70. *sorry I meant my insurance doesn’t cover the boot!

  71. Kristy,

    8 weeks in a cast sounds like a long time. Assuming you had surgery with no complications a cam walker boot may be in order. Many of us have already transitioned to shoes by 8 weeks post-op. The longer your foot is immobilized the harder rehab will be. Follow the rehab protocol links from the main page to get informed and take appropriate action. If you do get into a boot, resist the temptation to swim until your incision is completely closed and scarred over.

    My doc put me in a boot at 3 weeks which gave me the freedom to follow a rehab protocol of my own choosing. At 8 weeks I am walking in shoes on level surfaces but still wear the boot for risky situations.

  72. Kristy, for a good modern protocol that produced excellent results with and without surgery (you don’t say which you are), go to bit.ly/UWOProtocol . For the link to the study that used it and produced the excellent results, go to bit.ly/achillesstudies . If you need more specific directions, post something on my blog.

    It looks like you’re already registered on the site. So sign in, then try clicking on “About AchillesBlog.com” at the top left of the main page, then click where it says “You can create your own here.” it’s been a while since I did this myself, but I think that’s how it’s done. If not, I hope Dennis will notice and post better instructions.

  73. Hi All. I tore my left achilles tendon play squash about 3 weeks ago, had surgery about two weeks ago and approx one week ago started getting pins and needles as well as a burning sensation in the left side of my foot… it has been constant and the painkillers have not helped with this much. I went back to my ortho after a couple days of this (approx 10 days after surgery) and after removing my cast thankfully found no infection, removed my stitches and then mentioned that my problem is most likely b/c of Sural Nerve irritation. It seems that the swelling makes it worse and I could barely feel him touching the part of the leg that had the pins and needles so he refitted the cast (no splint) can cut a small hole in the side that had the problem to allow for swelling. Its been a few days since and the problem really has not subsided, though I have absolutely no pain in the achilles thankfully. Anyone else have Sural Nerve problems? Curious to know how long to expect the pins and needles last. Thanks!

  74. Danny, do you know if you had the more common “open” surgery, or if you had percutaneous surgery? Have you seen your incision? Is it one “slice”, 4″ or longer, or do you have 2 or 3 very small surgical wounds?

    In my casual “amateur” reading of medical studies that might be relevant, I recall that damage to the sural nerve is one of the more common complications of percutaneous surgery, and it’s much less common with open surgery (but it does happen).

    I can’t comment on pins-and-needles or “burning sensation”, but regional numbness is something I think I experienced both times (both with and without surgery), though mostly on the bottom of my foot.

    Sorry, that’s all I’ve got!

  75. Danny, do you know if you had the more common “open” surgery, or did you have percutaneous surgery? Have you seen your incision? Is it one “slice” 4″ or longer, or do you have 2 or 3 very small surgical wounds?

    In my casual “amateur” reading of medical studies that might be relevant, I recall that damage to the sural nerve is one of the more common complications of percutaneous surgery, and it’s much less common with open surgery (but it does happen).

    I can’t comment on pins-and-needles or “burning sensation”, but regional numbness is something I think I experienced both times (both with and without surgery), though mostly on the bottom of my foot.

    Sorry, that’s all I’ve got!

  76. Danny, I experienced the nerve issue you are describing. One thing I found that helped was sticking my foot in a bucket of warm/hot water which you probably can’t do until your scar is closed. I also did a lot of foot massages to stimulate the nerves. I had the problem for about 7-8 months post-op and one day I woke up and realized it was gone. My doc said that it can just take a while for the nerves to normalize again. My son, who severed several main nerves in a bad accident stepping on metal lawn edging, had numerous large zaps in his foot as his nerves were starting to fire again. (He almost took off about a half of his foot with the lawn edging slicing right through.) The doctors were AMAZING at reattaching everything. Anyway, don’t be alarmed if you get really intense jolts from the nerves in the region. It is actually a great sign. All of the different docs told me that what you have at a year post-op is pretty much what you are going to keep.

  77. Norm/Smish, thanks for the feedback. I got to see the ortho tomorrow to discuss further but he has said that the fact I have feeling of any kind means irritation rather than damage which is a good thing. I think I’m going to be in this cast for the next 4 weeks so I guess that I’m stuck with this sensation until the cast comes off…. but Smish its nothing quite like what your son wehnt through… sounds terrible. Thanks for the recommendation of the hot.cold water and foot massages, I think I’ll try that.

  78. Tore while playing tennis on 6/25, had outpatient, open surgery on 7/2. Today (7/14) was my first post-op visit, had sutures removed, cast removed, and am fitted now in an Aircast boot, was told I can do partial weight bearing with crutches - next visit in 4 weeks. To talk about rehab and PT at that visit, he said. I was told to wear the boot “when out and about, moving” but seems like I don’t have to wear it in the shower, in sleep, or if I’m just sitting around, and I am to start gentle flexion-extension exercises everyday. Feels really stiff, but finally can shave my poor atrophied leg! At this point I’m really worried about the good leg - it hurts a lot, probably from the hobbling, hope that one doesn’t tear!! I’m not really getting the partial weight bearing business, how much is too much? I guess I’ll figure it out, but it actually seems slower to get around than when I was NWB. I’m a physician myself, and am considering ordering the kneewalker rental to get back to work - scooting around the ICU where I work.

  79. Lotus, I think we all slowed down when we left the crutches behind. And you’ll slow down again when you move from the boot to “2 shoes”.

    PWB is usually a gradual process, that morphs right into “FWB as tolerated”. Initially it just means practicing the motion of walking on that foot, while the crutches still take all the weight. Then you gradually add some weight. Eventually, you’re maybe walking with 1 crutch or a cane for a day or two, then (in my case) forgetting where you left the cane!

    If your boot fits well and you’re using it (and the pressure between your shin and the top of the boot) to support your stride your AT should be fairly safe walking, with a little more or a little less WB. Many of us had pain in the bottom of the foot (esp. the heel) when we started WB, and that held us up more than any AT concerns.

    Your “good” leg does get a workout, and if you haven’t built up your “good” SHOE so it’s the same height as your boot, it’s a scary out-of-balance workout, that could “throw out” lots of your bod. There’s no perfect way, but FIND a way to elevate that other foot so you’re walking as straight as possible, it’s important.

    I eventually did tear my other AT, as have several others here, but I’ve never heard of anybody tearing the other one while their first ATR was still healing. So if you do it, at least you’ll be unique! ;-)

    The time you spend in and out of the boot is often a gradual phased thing, too. Some people have stiff or “shortened” ATs in the morning after sleeping barefooted, and it feels better to have the boot keeping the ankle flexed overnight, at least for a while. Listen to your body, and try to be sensibly and cautiously aggressive(!). Early WB and flexion seem at worst neutral and more likely beneficial, but re-rupturing is clearly a very bad outcome. (And start your own blog, too!)

  80. This website has giving me a great deal of information, and answered a lot of questions, but I actually sliced my Achilles tendon right in half. Has anyone else done that? Is the recovery the same? Let me know please. I sliced it a little over a week ago, and had to have Emergency surgery. Has anyone else had this happen? How long was your recovery, and is it basically the same as all the others? Any help would be great. I am a single mom of 2 kids a 4 year old and 20month old. I do not know how I will make it through this, but thank god for my family!

  81. Michelle, there’s one or two lists on this site, of our individual chronologies, including HOW we tore (or sliced) our ATs. You’re in the minority, but very far from the first. Sheets of glass, sharp doors, chainsaws. . . are all listed.

    I’m a leading member of the “Don’t get surgery!” Glee Club here, but I think surgery may be the best bet for AT lacerations (as opposed to “ruptures”). I think the recovery has been fairly comparable, but you can check the list for the login names, then check the individual blogs to see how this group’s “ATLs” have done.

    The reason it might be different (and the reason I like surgery for ATLs) is that a laceration cuts the sheath (”paratenon”) that surrounds the AT, while an ATR almost always leaves it intact.

    Nobody really knows why non-operative immobilization (with a fast modern rehab) produces an ATR cure that’s just as good as surgery (espiecially in the healed length of the AT!), but it has, in the latest and best studies. And the most plausible theories all involve that intact paratenon, which you don’t have. But your surgery should have gotten the length about right, and also re-attached the paratenon, so you should be at the start of a very similar road to a post-op ATR. I think! ;-)

  82. Start a blog and keep us posted — and it can be a guide to future ATLs, too!

  83. Full rupture playing basketball. Had surgical repair, wore splint w/bandages for two weeks and was fitted with a cam boot with two lifts yesterday. Incision is healing well (due to the religious amount of elevation I did), was given one out-of-the-boot and one in-the-boot exercise to perform daily, and was told to start FWB without crutches if I want to - which I was not expecting. I asked him to repeat the instruction and he said to walk without crutches. This seems really aggressive and I am fearful of a re-rupture. Has anyone else used this protocol?

  84. AC, my fave protocol — see bit.ly/UWOProtocol — specifies PWB (”protected” or “partial” WB) starting at 2 weeks post-whatever, which is where you seem to be. That protocol waits ’til 4 weeks for “FWB as tolerated”. OTOH, nobody knows, or agrees on, exactly what PWB MEANS, and it’s almost always a gradual progression from NWB to FWB.

    You could always hang back for a couple of weeks and follow that well-tested protocol, or you could try going faster. I’d say especially if you meet these conditions:
    - You don’t have any significant pain or discomfort, e.g. underneath your heel;
    - Your boot fits well, so your shin and the boot cuff can do all the work your AT used to do, as you roll over your booted foot, from heel to toe;
    - You TRUST the boot to do that, without feeling you have to push your toes (ball of your foot) down internally, to “help”;
    - You’ve done something to build up the height of your shoe on the other foot, so your alignment is reasonably straight when you stand and walk;
    - You’re not planning to walk in wintry or slippery or scary-crowded places for the next ~2 weeks.

    With all those conditions met, post-op (that protocol worked for both post-op AND non-op patients, and your sutures should add strength in these early days), it’s still a bit of an aggressive “stretch”, but arguably a reasonable one. Good luck, and do Watch Your Step!

  85. Normofthenorth,
    Thanks for the information. I walked today with crutches and I think I will do that for the first week, then decide if I am brave enough to walk without crutches while in the boot. The walking I did today did not cause discomfort in the tendon, but did so in the incision and I would hate to affect it’s healing. I’ll be ready with more questions during the next appointment. He is a great surgeon and professor, and as a result books too many patients at one time during appointments - so it is really difficult to ask questions and get a detailed timeline from him. He did say that I will be wearing shoes in three months; I just don’t have any of the detail between surgery and shoes. I’ll just follow his advice and post my progress with this protocol on this page.

  86. AC, that sounds like a sensible compromise to me.

    The protocol I linked has you in shoes before TWO months, so your Doc’s approach seems an interesting mixture of fast and slow. Check it out and compare. Ask him why his is better, if you like.

    Irritating a healing incision is indeed a Bad Thing, so do what you can to let it heal in peace. If he hasn’t prescribed exercise and PT, you could certainly ask him when he plans those. Again, you could do a lot worse than following my fave study’s protocol, because it produced very good results in a good-sized group of patients.

  87. Normofthenorth,

    Visited the doctor today for my 4 week post-op and boy was he astonished at my progress. He said the he has never seen anyone heal as fast I have and he has done hundreds of repairs. According to him I am six to eight weeks ahead of schedule. While lying in bed during the first week after surgery I figured out that the key to recovery was to not be sedentary and to battle atrophy. As a result, I have been walking in the boot as much as possible and have been doing isometric exercises with my calf and tendon. I purchased an indoor bike trainer and have been using it daily for the past two weeks (while wearing the boot). I told him I was doing this and he said to continue but to remove the boot and to be cautious while flexing the foot upward during pedaling. He removed a wedge (I have two now) and I don’t see him for another six weeks. He said to continue what I am doing and suggested that I may not need formal PT - that he would just give me some exercises to do on my own. Which is great because PT is expensive. I’m not going to push it too hard, but I hope to be wearing shoes in two months. I’ll keep you posted.

  88. Hi AC,

    As you may have gathered from other comments, Norm is going to be busy for awhile, having had a major surgery today.

    I think you are right about avoiding atrophy with early calf strength work, but the big medical studies haven’t caught up with us.

    When riding a bike, you can adjust the stress on your tendon by how you place your foot on the pedal. To eliminate tendon stress, pedal with your heel on the pedal. To increase the stress, move your foot back. You may want to lower the seat a little.

    It is quite a balancing act, being aggressive but careful at the same time.

    Best wishes,

    Doug

  89. It’s alive! Well, I am! Glad to hear of your great progress, AC. I seem to be flying along with mine, touch wood, one step at a time. . .

  90. norm - glad to see that you are back. :) I wish you a speedy recovery.

  91. Norm !!

    (This is the place where everybody knows your name, after all.)

    Great to hear your recovery is starting well. While playing basketball with the young folks last Sunday, I took a hard shoulder in the ribs from a college linebacker type, and have spent the rest of the week hoping not to cough or sneeze. I don’t want to think about how your surgery would make coughing or sneezing feel!

    I hope you’re feeling comfortable soon,

    Doug

  92. Doug, it hurts me just to THINK of your collision!! I clutch a cute red heart-shaped pillow to my chest now when I cough. I don’t want to think about sneezing yet, becuase it’s MUCH more violent than coughing, which is still a lot. The first day or two, even belching was a struggle! (And they check on all these gross things, too.

    So far, so good, almost without exception, and even the exceptions are minor — touch wood!

    Good Luck and Good Healing to ALL of us!!.

  93. Hi All - thanks for all the info so far and hope you are all progressing well!

    I completley ruptured my Achilles Tendon on Feb 28th I had surgery on March 1st and have been in a cast for the last 2.5 weeks. I went back today and had a new fibreglass cast put on. I am due to go back a week on Monday and need to decide whether I want a cast or boot - doctor is happy to do either but recommends the boot.

    I am confused. I have read a lot of the blogs and advice but I am not clear on the following:

    1. The recovery time for boot or plaster seems similar - what is the difference?

    2. The nurse told me that she would go for a cast as there was less chance of a re-rupture especially through falling - is this true? This is important to me as I have a 2yr old and have already fallen over his toys once!!!

    3. Does an extra week or so in a cast makes re-rupture less likely? I am not going back to footy so I just need to be mobile for work and need to drive - I cannot risk or afford a re-rupture and I want to take the safest option not necessarily the quickest - which is which is very confusing!

    Hope someone can shed some light :-)

  94. Hi Guys,

    I find this site really useful as a comparison to my own rupture on 1st Jan 2011. Is there any way of getting my own blog listed on here, or do I need to start again from scratch?

    http://seansachilles.blogspot.com/

    Sean.

  95. good news guys, i got my boot today 2 wks ahead of schedule. my PA originally told me i’d need a cast for 4 wks, but after 2 he put me in the boot. i’ll be in it for 4 wks. can’t walk on it yet, but he said i can take it off and move my foot around when i’m sitting or laying down. do you guys know if it’s ok to apply ice directly to the surgery site?

  96. Many post-op protocols say that it’s OK to shower after a few days, but not to bathe for a month or so. So I’d avoid soaking it. If you use an ice pack, or just cover the incision with some plastic wrap, it might be safer. No problem with the cold, AFAIK.

  97. okay so i’ve been in the boot for a little over a week after being in the hard cast for 2 wks. my question is, do i remove those little horizontal strips that they put on after removing the stitches or are they supposed to remove them? i want to start putting on the scar gel

  98. Hey Y’all. I need to buy a boot - I was hoping on input between the DJ MaxTrax (as shown above) or the Aircast FP. Will be moving from cast to boot pretty soon. THANKS!

  99. Hi All,

    I ruptured my achilles about 3 weeks ago playing rugby, and have been progressing well, post-op. I had surgery on May 29th, was on crutches (non-weight bearing) for a little over two weeks, and had a walking cast put on last week (June 8th), at a few days past the 2 week mark. I’m now full-weight bearing without crutches, and pain-free. I’m scheduled to have the walking cast removed and put into a boot in 2 weeks time (at the 5 week mark).

    I am also getting married the week following the cast removal. For obvious reasons I would like to be as mobile as I can be for this day.

    I’m just wondering what I can expect in terms of mobility by this point, based on your experiences? Any possibility of wearing normal footwear for limited periods, such as for pictures and the ceremony?

    Any insight would be appreciated! Best of luck in your respective recoveries!

    Travis

  100. Hi Travis - having just passed the 6 week ATR mark, and 3 days from 6 weeks since surgery, I believe you have a chance to be in a normal shoe for a short period of time. I am in a boot, FWB, and I am pretty sure I could wear a shoe, if I was pressed to do it (like your upcoming event).
    You should probably get back in a boot for part of the time, just to avoid a mis-step, like might occur after a bottle of champagne or something.
    For me, the biggest issue either way would be having to be on my feet for a long time. The foot/ankle tends to get swollen and a bit aggravated after long standing. You might want to have crutches along, to lean on when you will be standing for a long period of time. Congrats and Good Luck!

  101. We’d like your thoughts on this story

  102. Had my op 2.5 weeks ago. Went through insurance and was in for 1 night. I was fitted in to a half cast straight after the op and then 3 days later a full cast. I got my cast off 5 days ago and had the dressing changed before being fitted in to the vacoped boot. The consultant wanted a 30 degree movement setting on the boot but physio tried it and said it was too early……having nearly cried, I tend to agree!

    I go back on Monday which will be the 3 week stage and physio will set the boot to 30 degree movement which I am worried about.

    Is there a scan at some stage which shows whether the op has had the desired outcome? The last thing I want is to wait 6 more weeks for it to heal and then find it hasn’t totally worked!

    For those debating boot or cast………….. Boot all the way for me

  103. I would not worry about a scan or the 30 degrees at the 3 week mark. You will feel it a bit tight for a few days maybe but after that it will be much better. Around week 6 you will have a better idea of how things have gone and there will be no need for any scan. Your worries are normal though but most surgeries will do the job of keeping things together unitl your body lays down its own collagen to repair the injury, unless you do something too extreme. After going through this myself, my 81 y.o. father did his and with no surgery and a boot the entire time, he went to two shoes and a cane (around the house) in 6 weeks.

  104. Thanks…..any reason why I am not allowed to take the boot off? Everyone else on here seems to have been able to? Sleep is rubbish with the boot.

  105. Hey Pistol

    Everyone else doesn’t seem to. Chances are you are doing what we’ve all done and selectively read blog entries, filtering out the bits you don’t want to know and concentrating only on the bits you do. I guarantee you the bits you are not filtering out at best make up 5% of the norm.

    Most people sleep boot free around 5-6 weeks plus. This I would say is about the time when you feel less likely to do something wrong and more likely to have simply had enough of so many nights of crap sleep.

    I would personally say you should hang on until then as 2-3 weeks is still a very weak stage. Things you can do to help alleviate it are:

    * If your pain is in the heel, purchase a gel heel wedge. It doesn’t remove all pain but does help. I replaced one of my wedges with one of these as it was about a similar depth
    * If the pain is general leg stuff (this is the usual one), chances are your boot is getting a bit tight in the night. Best advice I followed was to take the front plate out and then do the boot up almost as normal, just a tiny bit slacker

    Both these things really helped me and still kept me safe whilst I slept. I won’t guarantee you every night will be good, but it will be better :-)

  106. Just a data point: I took the boot off to sleep at day 17. I worked up to it in the preceding days, starting by taking it off for up to a few hours at a time (for instance, starting at 4am).

    Things to consider:
    1) Are you alone in the bed? Any chance of getting kicked or rolled over on?
    2) Any chance of kids/pets jumping up onto the bed and hitting your unprotected foot?
    3) Do you sleep on your back/side/stomach? Toes pointed or flexed back?
    4) Do you sleep sound, or toss/turn a lot in the night?
    5) Any chance you’d “forget” and jump out of bed without wrapping it back up? (say if a fire alarm went off)

    Getting to boot (splint in my case) free sleeping was a huge step for me; a big increase in comfort. In my personal, non-medical, opinion, the risks aren’t that high- but there are smart people whom I respect, with good arguments, that disagree.

    One last sleeping tip from my experience: get a night light. The last thing you want while on crutches or hobbling, is to trip over shoes, dirty laundry, etc. in the middle of the night. A clear lighted path to the bathroom, sink, etc. is a cheap safety investment.

  107. Good post by Ryan there.
    As a heavy, toss/turning sleeper I kept my boot on lol!

  108. Thanks both….. Will go with the flow and ride it out.

  109. Pistol - I also suffered badly with sleep because of the boot and took it off to sleep at 3 weeks. It was a big risk but at that point my doctor had said I could take it off to start doing some active ROM exercises. That is to write the ABC’s with your foot while it is elevated. No stretching, just what your foot can do on its own. I slept on a spare bed for a couple of nights until I thought it was safe to go back to sleeping with someone else. I had a few spasms at night which woke me up but there was no trouble. Never walked anywhere without the boot on.

  110. Well………bit of a bad week! Started getting pains in my calf and went for an ultra sound. Turns out to be a DVT. Really disappointed as I only have 2more weeks in the boot and could start to see the finish line. Achilles is still quite tender and very tight but I have had the boot adjusted to full flexibility so it’s probably just the pain of stretching. Sleeping better but still keeping boot on at night.

  111. Tried some light exercises with the rubber band…….it is certainly making my toes curl

  112. Boot is off and mobility is good…… Very tight, swells up and aches occasionally but physio is doing it’s job…….. Running in 4 more weeks??? Hope so!

  113. Hi there

    Thanks for a great blog.

    I ruptured my achilles two weeks ago, had surgery almost immediately, and have been in a cast since. I have an appointment with my surgeon two weeks from now to have my cast off.

    However, instead of fitting me with a boot, he is going to fit a “caliper” to my shoe, which I will wear for another 6 weeks. Is this normal? All the blogs I’ve looked at speak about going into a boot, so I’d love to hear from anyone who has had the caliper experience.

  114. Michael, I have pondered on your question for a few days! I have a vague memory of somebody else having a caliper but Ive searched and can’t find it. I did try to find out some evidence but can’t find any useful info for you. Sorry to not be much help but I would be really interested to hear how you get on.

  115. I’m not sure where you’re getting your info, but great topic. I needs to spend some time learning much more or understanding more. Thanks for magnificent information I was looking for this info for my mission.

  116. full achilles rupture on 2/14/12
    1st doctor put me in a cast with my toes pointed down
    Went to a 2nd doctor for surgery
    surgery on 2/27/12
    1st post op appt 3/6/12 and got put into a CAM Boot. Doc told me i could start doing basic PT exercises at home.
    Dont know if i’m skipping certain protocols with healing?

  117. John - at an intitial glance is seems you are headed down the right track. Basic PT at 3 weeks would be moving your foot around with the boot and no weight.

  118. Full rupture January 27 playing basketball after 2 years of not playing (cautionary tale). My surgery was February 9. I was originally scheduled for January 31, but had another medical issue to recover from that stemmed from the same game. Anyway, I was sedentary for 2 weeks post-op … strict bed rest with foot elevated. I only got up to use the bathroom, eat, and bathe. I broke protocol twice to get out of the house but for the most part was on my back for most of the 2 weeks. I am now in a removable boot but NWB. I am doing band exercises and walking in a swimming pool. I take my boot off when I’m lounging on the couch or while I’m asleep.

    I have an appointment in 2 weeks in which I hope I can begin weight bearing “on land”.

  119. Jeff,
    I had a full rupture Jan 19, 2011. That was my second time. The first time was 10 years ago was in a cast for 6-8 weeks dont remeber but it healed. Last year had a full rupture again. Different doctor. He did what your doctor is doing cast for 2 weeks rhen boot. Was able to take the boot off when lounging and sleeping. You must know…. that I just had my third AT surgery March 6th 2012. That wearing the boot sometimes really messed up my AT. It did not stretch adiquitly and I have small tears threw out. I had to have a dibredment and they wrapped it in pig skin. I never built up doriflexion because of this. Im only a week out for the third time, but if i can give you any advise from last years exerience i home it can help. Please dont rush this. I have not been able to walk in 1yr 3 months. I now have to start from scratch for the third time. Best of luck.

  120. Hi, I ruptured my achilles 16 days ago. went into surgery 13 days ago, had staples removed 3 days ago and I am currently in a cast. The PA said I would be in 3 casts, the first would be my toes pointed down, then 2 weeks later my toes in a nuetral position, and finally 3 weeks later in a 90º foot flat. Then after 3 weeks in the final cast I will be in a boot. From the information I am reading on this site, many people go into a boot a lot quicker. My boot wont be on till 8 weeks after surgery.

    I am 28, healthy, and injured it playing basketball. Is it just cus my doc is playing it safe?

    Also if he is doing the right thing, the first cast which is supposed to have my toes pointed down is actually in a neutral position rather than down. The PA had a nurse do the cast but she was filling in for the regular ortho nurse. This nurse hadn’t done an foot related cast by her words 12 years. Should I go back to get it put in a toes down position? It’s confusing because on this blog one of the stories talks about going straight to a neutral position after stitches removed and no other cast.

    Any information will be helpful, this is my first surgery ever in life and im concerned, maybe too concerned.

  121. jin:

    8 weeks in a cast does seem a bit on the high side according to more modern protocols but not inconsistent with more traditional procedures. I would say that your description of how your toes are pointing and the fact that it was done by someone with no recent experience doesn’t sound right. I would say you should at least talk to your doctor and ask him about that.

  122. Hey
    Just found this site. Spent last few hrs reading it.

    Well, I’m 33yr old male.  I had a full rupture on right achilles playing basketball. Seemingly I was over training (weight training, basketball & training for Edinburgh Marathon). This’ll teach me :-/

    That was 21st March. Dr doesn’t operate anymore as there isn’t much benefit, 50/50 cast or operation (unless it’s a re-rupture and surgical recovery percentage is higher).

    So I was in a cast (ballerina pose) till 23rd Apri (4weeks). Foot moved slowly upwards for 2nd cast and that was removed today (21st May-4weeks again).

    8weeks in a cast!!! Still very swollen on ankle and foot?!? I thought that would’ve passed by now. 

    I now have the TruLife Value Walker boot which I’ve to wear for 2weeks non-stop. 1st week with both crutches, 2nd with one hopefully. Then it’s off and one crutch for 2 weeks while I try to walk and then I can drive again :-D

    Any good products I can buy to put in shoe or around achilles for when I start walking (so shoe isn’t rubbing and aggravating it), as I’m on feet working 11hrs a day with 4 hrs driving?

    Thanks

  123. Lee,
    Your current swelling is probably mostly from the casts putting constant pressure on and irritating specific areas of your foot and ankle. Same thing happened with me. I had NO swelling the first 2 weeks (post-op) in a splint but then had noticeable swelling after the first change of my cast @2 wks in the cast, 4 wks post-op. I got my cast off at 6 weeks post-op (4 wks in the cast) and still had the same (or slightly worse) swelling observed 2 wks earlier. The swelling actualy got a little worse as I went FWB and started walking in my boot. According to my Physical Therapist, the additional swelling is due to finally being able to move the ankle after being immobile for so long. Outside of work, I am now walking constantly in my crocs, but still have to wear the Bledsoe boot to work (company rules, no “open toes”). I cannot go entirely to 2 shoes full time until the swelling in my ankle and foot goes away–based on my positive experience at PT, I purchased an Aircast CryoCuff that should arrive tomorrow (I feel like a litlte kid, anxiously waiting for Santa to bring my big present)….
    Brian

  124. As I know the shoe inserts are the efficient treatment of foot soreness instead commences from wearing an even more at ease and relaxing shoes. Shoe inserts are located incredibly useful in most of the situations. They aid to decrease the signs of heel distress and plantar fasciitis.

  125. So i had surgery 5/9, got the boot on 5/29 and as of today, 4 weeks from surgery date, (6/6) I can walk around in the boot without crutches! The doc said this would happen at some point before my next appointment (6/19) but im a little nervous its too fast and i should go back to at least one crutch…. there is no pain by the way. thoughts?

  126. JS
    A big part of recovery is rebuilding your confidence. FWB in a boot 4 weeks after surgery Is quick but for most people not dangerously so. If you feel nervous about no crutches and it distracts you from concentrating on walking, use them for a few more days but wean yourself off of them as soon as you feel comfortable.

  127. Ruptured my Achilles 3 wks ago. Doc had to go “digging” to find the other half, and said leg would be really tight. Splint for first few days. Cast for two weeks with toes pointed like a ballerina. Went in for my air cast this week and was told to start walking (FWB). When I was being fitted for the boot, the tech inserted two wedges. Stretched and flexed my foot upwards til I was uncomfortable, set my foot into the boot, and even then was able to run his hand between the bottom of my foot and the top of the wedges. He stretched a bit more which started to become painful, and still had at least 2″ to go. Doc said get it in. Over the next 15-20 min, he forced it the final 2″. I was crying — no, sobbing. It was horrible! Doc says FWB, but my tendon and muscles are pulled so tight, I feel as if they are going to pop! Next visit is in 4 weeks — 7 wks post op — and doc says wedges should be completely gone by then. Has anyone else had this kind of experience?!? I can barely sleep or eat — so much discomfort –i’m really trying to stretch and bear weight.

  128. Hi Stacy - I went through this each time I had to “go flatter” with my foot. It was so bad that the first night I cinched down my boot (I have an adjustable hinge - not wedges) that I had to take a narcotic that evening. At 9 weeks today, I am only at about +3 active DF (above flat) because, like you, I had a very tight repair. (blew it to pieces and had to cut off lots of loose ends) Your leg should start to feel better within a couple of days. Plan wedge removal on days/nights when you have no PT or other important things. It was general misery for 24 hours for me - I just tried to have things for my kids planned away from home on those days. Many people don’t experience this - but I know EXACTLY how you feel!

    I did not WB during the painful first few days - but waited until the tendon had done it’s stretching and calmed down. I think you’ll be better off in the long run - I begged the doc to let me go more slowly and am really having a hard time with DF now.

    I’m so sorry - those were horrible days - I’m glad they’re behind me. Now it’s incremental stretching - although going from 5-0 degrees was the worst. The doc wants me to hang out at zero for a while and not go past until 10 weeks. Try and remove a wedge once a week - take a painkiller or two if you have to just to get through. I tried to tough it out and it was stupid. If you still hurt after 3 days, I’d call the doc. Check my blog as I may have forgotten something - those days were a blur! Praying you get some pain relief! Kim

  129. Stacy - I didn’t see that you had 4 weeks. Do a wedge every 2 weeks. You’ll start to feel looseness in your boot (up and down) when you’re ready. I was ready once in 4 days, and another time took 2 weeks. Sometimes you make faster gains and heal more quickly. No worries if it takes a little longer!

  130. Kimjax, thank you for replying so quickly. What is your blog address? I would really like to read more about your experience. It sounds as if yours and mine will be similar. It’s my second full day with the boot, and today is better than yesterday. I am not even close to putting full weight on it yet. Just sitting with my foot on the ground stretches! How will I know it’s time to suck it up and put my weight on it?

  131. Hi Stacy,
    Just do a search in the blog search box for kimjax and it will come up. I was the same way - I dropped my crutches at 5 weeks, and picked them back up again! I then went to one crutch for a couple of weeks, and you just “all of a sudden feel comfortable” walking by yourself. Some folks feel good really early - but every case is individual. Some people have 2 inch scars compared to my long one - probably indicating much less damaged AT and less “cut and sew” than mine. Someone with the same timeline as me came out of the cast with full ROM - bummed me out at first - but I’m just trusting that the doc knows his stuff - he said mine would be a little longer and more sensitive (read painful). I feel pretty good most of the time now - so hang in there! As long as you’re making progress, don’t sweat it. (easy to say now, lol!)

    Like I mentioned before, don’t try the weight bearing and angle changes all at once if it bothers you. A few others mentioned that they went temporarily backwards after angle changes - I did. Now that I’m at zero +, I can work on both daily, but during the early big angle changes I didn’t do a lot of walking while the AT adjusted.

    Most folks here will tell you to “listen to your body.” If it hurts a lot, don’t do it. Try a little at a time - then rest it. Riding a stationary bike with my boot helped build strength incrementally for walking. The stronger my legs get, the easier walking becomes. Be SURE to daily massage your leg while elevated and ice for pain. It helps a lot!

  132. I am at 8 weeks and still another week to go until I may get out of cast into boot. I had tendon replaced 6 inches with
    tendon from upper leg. I had one cast replacement at
    two weeks after getting it wet while watering lawn. I use
    crutches and no weight bearing. No pain at all just hope it heals well. My upper scar where tendon was taken from is all healed. It is a pain being on crutches and driving. I had a clutch vehicle so bought a new auto truck and drive with left foot. It takes a little practice to get used to doing
    the driving that way. Anyone have a tendon taken from their own leg and used as a replacement. I had a 12 inch
    cut to replace tendon. I had a inch at heal to attach and inch at calf to attach replacement tendon. The surgeon also used a cell jacket to wrap around the tendon for strength and cut down on scar tissue. It was a 4 1/2 hour operation. It may take up to a year to be back full strength. I am hoping 9 month’s. Even after getting the boot be no weight bearing for a few more weeks. I expect the PT when it starts to be very difficult but can hardly wait to be in that stage. I shoot archery and use my knee cart
    while shooting. This keeps me sane being able to still shoot at targets. It is sure a adjustment learning to live with crutches. I have a big respect now for the disabled.

  133. Hi all - Great website!
    Had so many questions for my OS but found it here instead.

    2 weeks post op and into the vacocast boot.
    OS said I can gradually FWB but as it is right now, when trying to PWB, there’s a pinch pain the ankle. Not in the tendon itself though.

    Is this normal or should I just slow down in trying to achieve FWB at this stage?

  134. I had a full rupture to the left AT on 6th July, 2012 and was placed in a cast. MRI three days later and operated-on on 12th July 2012. I was placed immediately into the brace system after the op and stayed with my toes pointing downwards for four full weeks with no weight bearing. I used a zimmer during this time as I was just too shaky on the crutches, Start of the 5th week, I began WB with the brace system on and began the PT. The brace system contained a total of 4 wedges and the first wedge was removed after the 6th week, 2 more wedges came out at separate intervals and by the 11th week the brace system was discarded altogether. I am now in the 14th week after the operation and am walking without the brace system. With a limp and one crutch - but walking. Hang in there it really does get better - slowly but surely.

  135. Hey I just wanna say thanks for making this page it helped me a lot with my injury I had a full ruptured achilles on July 8 2012 I’m now 12weeks out of surgery and I’m walking with my regular shoes with a slight limp. For all you guy and girls who are in early stages just relax and heal you will walk again trust me. Oh and please be careful with the blood clots keep yor leg raised I suffered a blood clot and was in the hospital for 6 days and in pain for a month the clot went to my lung and it was very difficult to breathe I’m lucky to be alive. Anyways I’m doing physical therapy twice a week and everything is going great with me now.

  136. I am now in my fifteenth week after the operation, no longer use the brace, am walking in normal shoes (clog-style to accomodate the swelling) and have one crutch. I have had eleven sessions of physio so far. The range of motion is coming back but I get worried by the trange sensation of the foot being “floppy.” Perhaps someone else has experienced the same. Any idea what this is? Is this a normal part of an ATR? Will it get better? Any exercises I should be doing? When will that heavy, floppy foot sensation pass? :S…..

  137. Well I must have read every site re the issue discussed.. 43yr old female full rupture while dancing to Scottish Kayleigh. Had op and Tom 3wks post op. trying to get well enough to travel on 13th dec.should have been 23 nov but not a chance. Just wanting a bit of advise- I should get my boot on 10 dec and trying to fly 13th dec, is this possible? How much swelling? Will I be able to walk without crutches?
    I am putting a bit of weight on my leg and seems ok, not full weight but trying to get back to normal.. Self employed ride horses and totally frustrated! Have started driving an automatic so work Tom yippee!

  138. Jill.
    It sounds like your recovery protocol is a bit more conservative then most modern and successful protocols which would put you in a boot as early as now and no more than 3 weeks from now. You can see normofthenorth’s blog for more details on these protocols. While you should be able to travel by 13 Dec., the more time you have in the boot prior to 13 Dec, the better you will be at moving without crutches. You might want to talk to your doctor about getting you in a boot sooner. Swelling could be an issue. I suggest that once you are in the boot, you get your self a compression sock. A sock with medium pressure worked for me. Also in any case. don’t be shy about using wheel chairs in the airport.

  139. Jill, is “Tom” short for “tomorrow”, or what?

    One of the most successful well-tested modern protocols is posted at bit.ly/UWOProtocol , FYI and FYDoctor’sInformation. That study’s patients started PWB two weeks into treatment (even withOUT surgery!), and went to “FWB As Tolerated” at 4 weeks. (In my case, I was FWB about two days after 4 weeks — or check my blog, because it REALLY remembers! ;-) )

    As Starshep indicates, it takes a while after the start of FWB to get comfortable and good at standing and walking. Typically, the heel and sole of our injured foot really don’t like being weighted at first, but gradually get used to it — sometimes with help from squishy insoles and maybe massaging by rolling it over a ball, etc. And almost always with the help of time and lots of rest and elevation.

    By 7-8 weeks into treatment — the time between your surgery and your plane flight — I was walking (in a boot) faster than all my “able-bodied” pals! I wouldn’t bet on your coming close to that, if you stay on your present schedule.

    So if you can bully your medical team into reading and following some newer studies (like Willets et al 2010, aka “the UWO study”, which is on this website), you’ll have a much better chance of walking and standing comfortably by Dec. 13th.

    Another potential concern is DVT, aka Deep Vein Thrombosis, aka blood clots formed (and broken loose) during healing, especially on the surgical path. As you probably know, DVT is a risk to passengers on (long) airplane flights even without leg surgery, and you’ll be firmly planted in TWO high-risk groups.

    Again, the risk generally fades as you progress through your rehab, so stalling in the early (NWB) stage before your flight probably increases your risk. One possible remedy is a daily injection (usually into the belly) of an anti-clotting agent, usually low molecular-weight Heparin. Some people find it painful. I had a few shots after heart surgery ~2 years ago, and I didn’t think it hurt much. It is also expensive, also not a concern to this Canadian. I’d guess that you’d only need a few shots, maybe starting just before the flight. Judgment call, and I’d defer to the real doctors for that one. ;-)

  140. Yep Tom short for tomorrow! Thanks for both last posts. Had my new pot today and my foot is nearly a right angle, does feel a bit odd though and my toes feel cold? Any ideas? They are thinking I will have walking boot on in 3 weeks so that gives me a bit of time prior to flight..the doc recommend aspirin prior to flight to thin blood. We are going to split the flight up to help with tvt. Have to say I am a bit nervous about recovery. Usually fit and active and was very unhappy about my now floppy calf muscle..Already using wheelchair but usually when wine involved! Thanks for comment as it is a help.

  141. I was wondering, i am 4 weeks post op. i have been in an air cast for two weeks and FWB for a week. I have no swelling and can put on my old schools with no problem. i have my 2nd Dr. visit Friday, any change I can push for be able to just take a shower standing up and not have to use a chair. When do you think i can FWB w.o the boot?

  142. meant shoes not school

  143. I just had my second post op visit today (4 weeks after surgery) and went from a cast to a boot. I am still NWB for two weeks. Since being put in the boot I am experiencing a lot of pain in the back of my heel and calf. Right now I wish I still had my cast. Did anyone else experience this sort of problem when transitioning to a boot? If so, how long did it last? They didn’t change the angle of my foot so the pain isn’t from stretching the calf/tendon area.

  144. Hi all, I’m almost 8 weeks post op and in a boot for 2 weeks. I’m having difficulty sleeping, with increased sensitivity of the foot and soreness. RICE and Vicodin do not help. Any comments/suggestions would be much appreciated.

  145. I hope Susan got relief.

    Charlie30, you should ask your Doc. Your PT might be able to help, too. Improvements aren’t always continuous and daily, but you shouldn’t have it that bad now…

  146. Hi All,

    I’m 29, originally from the UK but now living permanently in Holland.

    I ruptured my achilles 11 days ago and had surgery the day following the injury (for some background, I was playing badminton at the time). I was sent home the same day with a semi solid cast and had this non-weight bearing cast removed yesterday (day 10 post operation).

    Having read a lot about post operative procedures, I was pretty horrified when the process in Holland was to literally take the cast off and give me an ankle support with a 6mm silicone wedge to put in my shoe and told to go home and walk.

    I was expecting some sort of walker boot with some feeling of support with the extended heel wedges so the tendon can be stretched over time back to a normal standing position. The wedge provided was so short I can not physically stand let alone walk.

    My home doctor did a house visit today, took one look at the ankle support and proceeded to cut me out of it because it was so tight I couldn’t get it off without being in intense pain. It also caused swelling to my foot and toes. Pins and needles is also being experienced ever since the operation (is this normal?)…..

    I suppose what I’m looking for is some sort of recognition from you all who have experienced this injury that my gut feeling was right about the ankle support. I have another appointment with the same hospital department, as arranged by my doctor, for this coming Monday. Should I be more insistent about the walker? Is it too soon after surgery? Any advice (help!) would be greatly appreciated!

    I’ve been living abroad now for 6months and trying to work my way around a foreign healthcare system is proving to be a bit of a nightmare so thank god for this blog!

  147. Hello everyone, I’m 24 years old and am 4 weeks post surgery from completely rupturing my Achilles’ tendon playing basketball. Two days ago I had my second post op drs appointment and they removed my hard cast and put me in a boot. I’m going to be in it for 4 weeks, two NWB and two FWB. The reason I’m commenting is because I have been up all night with the worst pain since the night I ruptured it. Elevation hasn’t worked, pain meds haven’t worked, and I’m starting to get worried. The pain can be described as a throbbing pain in my upper heel with sharp stabbing pains in my lower heel (the worst). I haven’t done anything to cause this pain and have been relatively pain free since the first week post-op. is this normal? I have remained very positive throughout my recovery but I’m also in my last semester of a teaching program and I student teach at a middle school everyday. I can’t afford to be up all night with pain. If you guys had any suggestions that would be great. Thanks and good luck to the rest of you on your recoveries!

  148. Quinn5- it is possible your pain is related the new position your foot has been put in as a result of the change from cast to boot. If that is the case then it should settle down over a few days but if you are concerned then you should see your doctor. I doubt you have done any damage to the surgery or tendon. Most important for the moment is to manage your pain so you can continue with your work. I used to laugh when in hospital and a nurse would give me a couple of headache pills when I was in real pain but since this injury I have realised that 2 x 500mg paraceatamol every 4 to 6 hours really does control pain. Do not exceed the recommended daily dose or take more than 2 at a time but take them regularly even if you are not in severe pain. That is the key to long lasting pain relief. They will not make you sick, drowsy or constipated and you will realise when you forget to take them how much they do work. Give it a few days and then ease off the meds to see if things are better. Not sure where in the world you are but I think the brand Panadol is sold world wide over the counter. Hope it helps but again I stress that you should consult a doctor if concerned or unsure.

  149. Esp if the pain is inthe back of the heel, I’d call the surgeon. OTOH, pain UNDER the heel is common when starting to WB. But you’re still NWB, so not common.
    One guy here recently reruptured from going from cast to (badly adjusted) boot, so bad stuff does happen, occasionally. Does it feel as if your boot is much closer to 90 degrees (AKA Neutral) than your cast was?

  150. @xplora thank you I will definitely look into that. I have been taking 10mg hydrocodones every now and then but I took 4 last night. Surprisingly, when a loosened the Velcro closest to my heel, the pain eased significantly. @normofthenorth I don’t even want to think about rerupturing it haha. My surgeon just looked at it 2 days ago and said it looked healthy and normal for the amount of time it’s been. He also (knocking on wood) he’s never had a re rupture so that was relieving. Thanks for the feedback guys!

  151. Hi all,

    25 year old medical student, incredibly active before injury.

    Full rupture in freak accident playing squash. Mulled things over. Got surgery 1 week later. Turns out I have a sensitivity to opiates (needed naloxone on extubation), also had laryngospasm (needed succinylcholine). 2 weeks of NWB in hard cast. Stiches out and swap to Aircast at 2 weeks. NWB for another 2 weeks (even though I was sure I could put weight on it). Now I’m at 4 weeks post op under WBAT instructions but I can easily walk around with aircast (2cm heel lift). I feel very lucky that I seem to be on the fast side in terms of recovery. I have macgyver-ed a platform shoe for use at home so that I am level on each side in order to walk somewhat properly.

    My question to you guys is: what strategies/methods/products do you guys use in order to raise your OTHER (healthy) foot during FWB walking in aircast in order to have a proper gait?

    Thanks!

  152. I got my boot on first follow up. Was amazed how weak my leg was and how heavy the boot was. After few days I’ve gained a lot of strength back feeling 1000x better.

  153. Hi Folks first off thanks for all the info regarding the ATR. I have been checking this site out for quite a while now and have found it so informative and helpful lot’s of really cool folks out there thanks.
    I am at my 12th week post op. Just the other day my doc said it was ok to remove my boot and start walking…just like that. Won’t go into my doc’s bedside manner…that’s another story. I have been doing PT for about 5 weeks and the doc says I still need to strengthen my leg. SO…I started slowly walking without my boot on— going on 4 days now but I find it difficult to continue because I have a pulsing pain at the AT location. It only “pulses” when I push up with the balls of my foot. In other words when I try to approach a normal gait or walk. I called my doc this morning but of course his secretary relayed the message to him about my pain and the secretary got back to me to let me know that my doc’s response was “Wear the boot outdoors, sneakers indoors” that’s it.

    Can anyone speak to the levels of pain one should encounter the first days without the boot on? Is this is a pain that you sort of have ot work through? I know everyone’s case is different but any ideas would be great. I see my therapist tomorrow and hopefully he can liaise with my doc with better results, we’ll see. In the meantime any advice would be helpful.

    Thanks

  154. Were you FWB and walking fast in the boot before your doc put you in shoes? That’s the usual progression, though switching to shoes is still usually a “stretch”.

    When most of us get into 2 shoes, we CANNOT push off with the balls of our injured foot, as we would normally. The AT is still too weak and “nervous”, and the calf muscle may also be too weak and atrophied. (The ankle may be stiff, too.) So we mostly start with an asymmetrical stride that’s way shorter when our UNinjured foot is striding past our INjured one. As long as that’s the only thing that’s weird about your stride, I think you’re fine. As time goes on and your strength and flexibility increase, you’ll gradually lengthen that shorter stride. And you may find that you’re still stuck with a little “dip-limp” at the end of that stride for what seems like a frustratingly long time — and then it’s finally gone!

    I would avoid pushing that push-off for now, especially if it causes pain, and doubly-especially if the pain is at the back of your leg, near your AT. Timing is everything, and a perfect exercise can do serious harm if you do it just a little bit too soon, or do too many.

    This is NOT an experience where “working through the pain” is rewarded. Incrementalism is. If you have spend most or all of that 12 weeks at less than FWB, you have some catching up to do, but you have to do that gradually and incrementally, too. Often, when we’ve pushed ourselves into pain during ATR rehab, it works better to back off seriously, until the pain is really gone, before pushing again. People who start up sooner, trying to maintain a just-tolerable level of pain and save some time, sometimes create a chronic problem that’s hard to resolve.

  155. Day 21 post-surgery. I (38 y.o, male, gym rat) feel good, all things considered. Almost non-existent pain from injury (basketball) to surgery to now recovery. I have read through many posts throughout the site and haven’t come across an initial recovery, pre-PT, quite like what my doc prescribed. I would appreciate your opinions.

    From immediately after surgery my doc, a well-regarded sports medicine ortho surgeon, said 6 weeks in a cast with slight changes in foot angle with each cast change every 2 weeks. He cited that I ruptured it high, near calf muscle which apparently is a slightly weaker/thinner part of the AT.

    At my first post-op visit, I asked when I would be put into a boot. To my surprised, he said I won’t need a boot. He said he prefers to stabilize the AT and let it heal over 5-6 weeks then walk with crutches, no boot. No boot? Hmmmm!?!? Has anyone else gone with this recovery approach or read any posts here that are similar?

    As I have frustratingly watched my leg atrophy, I am tempted to ask to be out of a cast after 5 weeks and into a weight bearing boot. In part, I want to get back to the gym.

    7 more days til post-op visit #2. Fingers crossed, will update here soon.

  156. SitS: Boots are better than casts, period, IMHO. Rehab with a boot can introduce PWB and FWB earlier, as well as PT, exercise, and hygiene. All of those seem to be beneficial, and all the most successful published studies used boots, sorry. Hope your OS is old. The Studies and Protocols page on this site has a bunch of studies.
    The good news is that post-op patients seem to suffer much less (in worse risks of bad outcomes) from inferior rehab protocols than non-op patients. So your prospects are still good. It’s logical that you’ll have more atrophy from longer complete immobilization, especially if all 6 wks are NWB — though I’ve seen no evidence to prove the logic is true.

  157. I’d like to throw this question out to the world. I used the aircast boot for my first rupture but am wondering whether a boot that gives ROM would be better than fixed and the removal of wedges to adjust the angle? I know the Vaco is the gold standard but there are cheaper alternatives. Would I benefit from an incremental boot or stick with the aircast? Thoughts please!

  158. The evidence is weak, but I prefer hinged boots. No diff during early fixed-angle phase (wedges = fixed hinge), but walking in a hingeing boot is a great transition betw fixed boot and shoes. I got a hinged boot for my first ATR, then my new OS sold me an AirCast for ATR#2. I used it til ~week7, then went into the hinged boot for my last booted week and all my returns, for scary outings.

    The Exeter study used hinged, the UWO fixed. I think Exeter did better post-op, and it’s a tossup post-NON-op. And Exeter got to FWB sooner, which is a benefit (to patients and family!).

  159. Hi I just had my second follow up and cast was removed in favor of a boot. In my cast I was toes down 25%. The boot is now toes down 10%. I was told not to use scooter or crutches anymore. I feel as if my heel doesn’t’ hit the bottom of the boot and the pain is pretty intense trying to get it to bottom, and I feel in no way can I bear weight on it. I’m wondering if it’s normal to go from 25 to 10 percent and FWB, should I use crutches and PWB? I am at 4 weeks from surgery?

  160. Went to 2nd visit (3 weeks post ATR/surgery, PWB from 1st day) yesterday.
    They checked the tendon and said it’s getting there fine. Good :-)

    I asked about moving things, I was told: Absolutely not. Nada. Keep it in the boot, when removing for washing make sure to stay in plantar flexion as much as possible to keep any strain off the new tendon. No wiggling of toes, no moving the foot - nothing. Wash and put back into boot.
    Definitely no fooling around with no boot on!

    One more week and I can go FWB, also reduce plantar flexion in boot from 15 degrees to zero. But even then - still no movements or anything outside of boot until week 6 when I get to remove the boot and get into 2 shoes.
    They were pretty serious about that, too.
    Gee, ok ok, keep your shirt on … :-)

  161. jk…, I’m a firm believer in NOT stretching a healing AT as hard as your folks are doing. I’d either back off the stretch or leave it unweighted (PWB) until it feels comfortable.

    NN, I’d ask to see your Doc’s evidence, to see if his results are half as good as UWO’s and Exeter’s. If not I don’t care how adamant he is!

  162. Hello Norm,

    apparently his “protocol” is in line with what the boot company (Vacoped) is saying. He actually went through great lengths to re-explain even how to put the boot on. Get in, tighten and adjust the 4 velcro bands in the proper order, then apply vacuum, potentially re-adjust the velcros afterwards. He wants the entire scenario very immobilized. While this is no doubt very conservative, the fact that I was PWB from the first moment on is more on the aggressive side. 0 Degrees after 4 weeks and 6 weeks in 2 shoes I guess is state of the art as far as I understand. My boot is actually rented from the boot company, they already gave me the RMA, box and date for the return.

    I don’t have sutures like apparently many people here, my tendon was sewn and glued with material which gets dissipated by the body auto-magically. Maybe that’s the reason for the high immobilization because it might be less strong and more vulnerable to re-rupture at an early stage before it is completely healed. In return I don’t need suture removal and have a very small scar - I estimate somewhat less than 2 inches and it’s already (3 weeks) quite invisible.

    Amazingly, my bad leg is actually reasonably stable now in terms of atrophy. I seemed to have lost a lot of mass quickly after surgery (first week) but since then it seems to stay the way it is.

    The doc checked fairly carefully how the tendon is doing and I think he also checked for bad attachment to surrounding tissue and assume from his statement that he found none. In the bathtub today I looked at it myself and find it actually already very normal looking and feeling. The bony part of the ankles is a little swollen but the rest of the foot, heel, leg even achilles area itself looks practically normal.

    So, all in all, while I do understand the implication and draw backs of strong immobilization, I currently cannot complain, everything seems to go quite well. The docs seem to be very knowledgable, neither on the bored, nor the “oh shit, what is an ATR” - side. I am friends with the head of the “internal medicine” department of the hospital so I might have an unfair VIP advantage but somehow I want to believe that this is the way they would treat everybody. At least I hope so.

    When they did the surgery they sent short pieces of both torn ends to a lab for histology. The lab reported “nothing malignant” but claim to have found pre-existing damage without being very specific on what that means.

    The doc looked at my good AT and said it’s better than his own which he actually showed me too. He said his is swollen and he’s waiting for ATR to happen to himself. I honestly could not spot the difference. He did claim that squeezing his AT with his fingers hurts while when he squeezed mine (the good one) the same way I didn’t feel anything.

    Asking around (for example the doc who removed the stitches) that hospital, specifically the ER/orthopedic surgery and sports medicine department does have a very good reputation in the region and even well known athletes have been going to that place lately.

    While all that of course is not a guarantee for anything, it does give me a good feeling and correlates well with my so far very good experience.

  163. OK, NN, it sounds like you have about as much basis for confidence as a person can have without evidence! :-)

    I wonder if some of the “no toe wiggling” you’re getting is overcompensation because you seem like a daredevil. Otherwise it seems more immobilized than the other Vaco protocols I’ve seen, including Exeter. The 4 & 6 week steps seem aggressive, but I’d still be nervous about attachments with no early wiggling.

    I don’t have much faith in calf measurements in early times when there can still be inflammation around…

    Where are you? Working on a blog, with a widget showing us your details?

  164. Norm,

    not a daredevil at all! In fact, more of a chicken than anything. I’d rather take it way easier and err on the side of precaution on this one than to risk a re-rupture or other problems. I think the “no wiggle” policy is essentially German engineering as practiced by a doctor. When you do something, you do it 100%. “Which part in immobilize do you not understand?” - sort of. I don’t subscribe to that point of view, I am German and an engineer, but I see reality to be more complex than that. However, here I don’t have any better knowledge, so I more or less adhere to what they say. I do wiggle a little all the time, though, but only as much as my engineering brain tells me cannot possibly be harmful as it is within the spec of the boot and thus tolerable by the inventors.

    Seriously - I am EXTREMELY empathetic to anybody here especially with a re-rupture. “I will not abide another toe!” if you know what I mean :-)

    I have been eating very healthily lately, added a small package of pure gelatin (collagen!) daily, take vitamins and minerals and practically no alcohol (another upside of this).

    I have ordered new “2 shoes” already and will get multiple achilles support braces/socks for the time after the boot.

    In addition, I am thinking the following:

    No movement at all in boot until end of week 6, then boot gone and 2 shoes - that seems an unreasonably abrupt step for me. What I’ll do instead is this:
    Beginning in week 6, I’ll open the hinge of the boot to allow a few degrees of flexion in “ROM” mode. I will then wear the boot two more weeks like that, taking if off at night and during plenty of “chill” time on the sofa and during work at a desk with an elevated foot, but wear it during the day allowing more and more flexion but protecting the foot from stupidity.
    In addition, I’ll get a cross trainer and start training on that as I believe on a cross trainer (while I have never been on one) you are pretty safe from mishaps while being able to do a good workout for the entire body. I’ll get one for my home, actually. In the beginning I’ll probably wear the boot even while on that thing but based on comfort level move to shoes on the cross trainer and then back into the boot afterwards.

    I am in Munich, Germany right now. I am originally from Germany, have been living in Silicon Valley since 97 though. On Thursday I will fly home, I just booked a “Miles” ticket with Lufthansa in first class so I have room for my leg. I wanted Business but it’s not available. Lots of miles, but worth it in this situation.

    Anyways - that’s my thinking: I am not rich, not by any stretch of imagination, but for this thing I spare no expense. I want this to go away and never come back. It’s a good experience to learn the value of health, but I got the point now and want to move on. That’s what savings (Miles, Money whatever) are for - to be used in moments like these. In addition, I’ll keep this learning close to my heart and pay way more attention to every single body part. “I need my f**ing Johnson!” :-)

    I know what you mean by “attachment with no early wiggling”, I read the terrible stories, I will pay very close attention to how that AT is attached in itself versus the surrounding tissue. If it’s not obviously well independent, I will not run around on it. It’s hard to say right now as the scar itself is not yet very flexible in itself (while it is looking quite well healed) and thus I get immediate pain-ish feedback from it with even the slightest wiggle. However, once officially allowed outside of the boot even by the engineer-doctors, I will start massaging it aggressively to determine if it can be trusted.
    And use that cross trainer…

    By the way - this portal is totally cool. It’s awesome to be able to exchange thoughts with so many people in similar calamity. That way we’re literally not alone. “May the force be with you!”, my friends! I am happy with every achievement by anybody here and deeply compassionate with every new inglorious basterd showing up or setback of existing members of this questionable club.
    After all, it’s empathy, not just an opposable thumb which makes us human.

  165. To add to my former post:

    I called the Boot people today as I am flying back to Silicon Valley end of this week I need to make sure I can keep the boot for longer (mine is a rental and the return date had been pre-set according to the rather aggressive schedule I am on)

    On the phone they told me they second my opinion on using the boot for quite a while longer than originally planned by my doc. (They are not really making any useful additional money out of that)

    Thus, by using the ROM feature of the boot I will gradually increase flexing of the ankle instead of simply jumping into 2 shoes at 6 weeks post op. I am not yet sure as to how long I want to stretch this, however, from reading a lot of posts on this excellent site, I am taking the following (special mention to Norm who obviously has done a ton of research here) :

    SOME movement, very slight flexing and even careful stretching is useful and actually important for the new tendon early on, however, trips, mishaps and that sort of thing can still be deadly even long into “2 shoes time”.
    Mechanically this makes perfect sense, as during a sudden, jerky “catch me” movement, the amount of force on the tendon is way higher than on a careful, slow and well controlled “flex”. After all, something jerky and uncontrolled has caused even the healthy tendon to rupture in the first place (well, for most people anyways).
    In addition, any additional strain on the tendon which is useful for teaching it that it is a tendon and has a job to do needs to be followed by a period of rest in which the tendon actually has a chance to react to this and grow stronger. Muscles take a few days to “heal and grow” from exercise induced stress, tendons and bones are much slower growers and take a few weeks for the same thing.

    Thus, I am starting to believe in a more gradual approach to the whole damn thing.

    I am trying that in multiple ways. Instead of going from PWB to FWB in one “jump”, I am starting MWB as in “more weight bearing” now. Starting by standing on both legs, still using crutches for walking and support but gradually putting more weight on the busted leg. Of course in boot.
    Also, instead of moving the flexion ankle from 15 degrees to 0 degrees in one step, I am using the boot’s feature to move in 5 degree increments. Did one just now, actually a few days before I am supposed to go to 0. I’ll leave that for a few days, then go the next 5 degrees and so on.

    When at 6 weeks, supposed to go into 2 shoes, I will take boot off at nights, start some massaging, get on well controlled exercise equipment (like elliptical cross trainer) and otherwise use the boot in more and more ROM mode while walking around doing daily things.

    I’d rather extend the slightly handicapped time considerably than taking the considerable risk of having to do it all over.

    “Getting us back to work earlier” as advertised is actually something I want to throw back in “their” faces - we are not cattle or other forms of “return-on-investment” human capital, we are people and we have a right to live our lives the way that is best for ourselves and not as a means to somebody else’s end. Re-rupturing and being out for the count or even longer is obviously devastating useless and should be avoided at all cost.

  166. Hi, you’re interested in using the rom feature of the boot and I’m guessing that you might not have read Suddsy’s blog which last year (?) had a number of us contributing from our own experience as well as detailing the Exeter and UWO protocols. You could do worse than start at achillesblog.com/suddsy/2013/06/24/end-of-wk-2-wow-progress/ . Some quite ambitious stuff there but tried and tested by yours truly and many others here.

    Good luck

  167. NN, I give +1 to Hillie. You’re falling into the logical trap of assuming that going slower is safer, when the bulk of the evidence says the opposite — at least up to the speed of UWO or Exeter. Otherwise +1 to yours too!

  168. Norm, you seriously might have a point. Today I moved to 5 deg after being at 10 deg for 2 days and that is definitely noticeable, almost painful just like that. However, once I get on the leg, I can really feel it pull and it is actually painful. More than 30kg (measured) of weight on the leg starts to become seriously painful to the point that I can’t get myself to do it. The full 90kg? No way!

    How was I supposed to go from 15 deg PWB one day to 0 deg FWB the next day if I can’t even do the baby step I am attempting instead?
    Did I already keep it immobile for too long that I now have to suffer through this?

    Whoa, I’ll shut up on wild theories in the future and first see what reality has in stock.
    Looking forward to hearing what PT has to say on Friday.

  169. A few points:
    1) Keep an eye on UWO & Exeter! UWO did well with 2cm (~20°) for 6 weeks then cold turkey to neutral. I disliked the cold turkey, so I took a few days, 1 wedge a day.
    2) Timing of angle change seems to be variable among successful protocols.
    3) If it feels too fast, I think it is.
    4) Safest way to change is at bedtime, then sleep in the boot at the new angle. Ankle gets 8 hours of NWB to get used to the stretch before you load it up.
    5) If you do find yourself behind a good protocol, never jump ahead. Keep everything INCREMENTAL! (Everything!)

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