6 weeks post tear and boot at neutral
Went to PT on Monday and testing showed that my range of motion was virtually identical to the left foot with a 15 degree dorsal flexion with no strain at all. Ginger (My therapist) suggested going right to zero degrees on the boot and really start the weight bearing in earnest. She has me doing some marching in place, leg raises to the side and back as well as controlled heel raises while standing and holding onto a table. I can do them but only slightly as I feel a bit of pulling at the tendon tear site. The muscles are definitely hooked up though as I feel them flexing and tiring as I do the exercises. Still three weeks until I see Ortho Doc for 3rd visit but I am perfectly happy at neutral position and one or no crutches. I set the table, emptied the dishwasher and made my self a martini with no crutches last night. You can do so much more once you ditch at least one crutch.
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I’d go easy on any heel raises at 6 wks. Keep an eye on bit.ly/UWOProtocol . You’re roughly on their rehab schedule, don’t get too far ahead of their exercise schedule.
I love your prioritization of the first non-crutch activities!
Great update.
Keep it going, and good luck.
Ron
@chuckv I’m where you are pretty much. Same weeks, but maybe a half to a full week ahead. I also went to neutral with the boot right away, and on the 3rd day I was fwb. My pt consist of strengthening bands exercises mostly. Today I walked in 2 shoes all day with no real discomfort, but tom I’ll prolly take it easy. No heel raises for me other than sitting, but my calf muscle is coming back really fast. Next appointment 2 weeks from now so we’ll see if they want me to go to 2 shoes or not, but by then I assume I’ll be walking in 2 shoes full time for a week or so at this rate.
In doing my new exercises I have come to realize that, despite my PT’s enthusiasm and satisfaction with my progress, only I can truly be the judge of how fast we should progress. The little pinch in my tendon and attendant aftergow after some modest standing heel raises was enough to tell me to slow down. I will certainly express that opinion today at my session. I really think that there is only so much that can be done to move things along in these early PT encounters. Massage, laser, stretching then what? Strengthening but how much is safe at an early stage? Getting the limbs and joints to work again seems to me would be a high priority. Stationary bike is good, hamstring stretches for me are key. I started having problems with non affected leg’s knee at the back. I use a 6″ by 36″ foam roller to work the hamstrings and calf muscles. I rolled up a small hand towel and tucked that under my left knee and squeezed. That helped to relieve the tendon pain there.
Man, you have to find every trick you can to get things ready for the day when you can walk again. If you don’t prepare by strengthening and stretching those other parts too you will be disappointed in your abilities even though you think it should be a breeze.
I am a month out today…I have no pain and swelling is gone, it barely looks like I had surgery. Even after therapy, I am never sore, my tendon did not shorten when it ruptured, so I got lucky. I feel like I should be doing more, because when I’ve done rehab in the past, I’ve pushed myself to the point of pain and soreness…My range of motion is good, and I only feel it when I flex my foot with my toes to my chest. I am supposed to be partial weight bearing in my boot with crutches, but I dont need the crutches…I have no pain bearing weight…any advice on where I am at? I am 29 years old, ex professional baseball player, that ruptured it in a dek hockey game, back pedalling.
Hi Doug, Glad to hear things are progressing well. My comment would be this regarding your enthisiasm to step on the gas:Since you had surgery, you have a mechanical connection between the ends of your tendon but you still have to wait for all those fiber ends to make their new connections before you are truly back together. This takes time not necessarily work on your part. That’s why conventional wisdom is to let the sucker sit there and stitch for 8 weeks because I think that’s how long it takes on average. Now, any type of exercise which keeps everything “oiled”, should be pursued in my opinion. It’s easy to get confident if not overly confident when everything is feeling good. I know I get to feeling that way sometimes. I shudder to think how I would feel or for that matter how my wife would feel if after investing 6 weeks of careful recovery activities that something should happen to put me back to day zero.
As Han said to Luke, “Don’t get cocky kid.”
Time AND work both — but too much work/time is harmful. Without work, the tendon knits together, but with weak stuff instead of strong rope fibers; it’s got to be worked — gently at first — to “re-learn” to be a tendon.
The best rehab protocols — like UWO & Exeter — are the best evidence-based guide to how much how soon. But “just let it heal for 8 weeks” does NOT work well (though less awfully post-op than non-op).
Doug - just want to double up on all that has been said and add a bit more. Like you I would normally push rehab for injuries but this one is very different. I would suggest you do some reading on how tendons heal or ask your PT. Unless you are wolverine there is a fairly precise timeline. 4 weeks FWB is not unusual and is no indication you are healing super fast. My father (84) was weight bearing from day one and I started FWB between 3 and 4 weeks. The initial collagen has started to be laid down but it is weak. About week 6 most of the collagen is down but it is a type that is disorganised and week. Up to week 12 you are in the high risk for re-rupture and then it tapers. Your body will not give you much warning so your rehab needs to be organised and incremental. Some people push things and get through while others go back to the start because they pushed too far. My page (Xplora) has some further reading on how tendons heal but a google search will get you some answers as well. There will be plenty of time to push hard soon. The anit spam word is patience and again it fits.
Nice to see where you are at, you are two weeks ahead of me and I am looking forward to what it will be like to lose a crutch in a month or so!
Went to PT yesterday afternoon and told them that I was uncomfortable with the heel raises at this point and they suggested a modification where instead of standing, I lean over a railing or table. This works while distributing less weight on the feet while still allowing the legs to remain straight. Seated heel raises exercise the soleus while standing ones work the gastrocnemius. If you have crutches you can plant them in front and then rock forward while raising off your heels. This gives a nice controlled lift. Caution: Do this on a carpet so your crutches don’t slip away from you.
Thanks for the comments…went and saw Ortho who did surgery on me today…his assitant adjusted my Dorsal Flexion to 0…. there is no settings sheet for camboot on protocol..before my Physical Therapist told me if I can’t walk normal with boot and settings, I needed to use crutches. When I set it to 0, I can’t walk wihout a limp and I feel it all the time. I adjusted it to one setting less…and I am doing good with it, what should I have it set on? I will be at 5 week period on Thursday. I understand what you said earlier about not pushing it either..Once I put it to neutral…I could feel it again…
I just went to neutral this past week and am full weight bearing with no pain at all. Most of the pain that I experienced during my recovery from the first ATR was at the suture site. Scar pulling and a bunch of internal adhesions I think. That’s probably what you are experiencing. Use a crutch on the opposite side and take some pressure off. I would think that 10 to 20 degrees would not be unusual for your time line. Seems a bit early for neutral in my opinion.
douglasmcnulty, I don’t think I’m clear on what you’ve got. Is your boot set fixed = rigid, or free to hinge = “ROM”?
If it’s fixed, then you’re asking about having it set at neutral = 0 = 90 degrees, vs. having it set a bit more PF = toe-down = extended = equinus. If that’s it, my own theory is (a) that your ankle will usually tell you when it’s ready to stretch to the next step toward neutral — though it makes sense to keep an eye on a good proven protocol, too. And (b) when you do switch closer to neutral (like removing a heel wedge), I prefer doing it at bed-time then sleeping in the boot, so your leg gets used to the stretch BEFORE it has to get used to having your weight pushing that stretch.
If your boot is set to hinge, I think similar principles apply to the DF end of its ROM range.
Another Rule of Thumb is that nobody should be limping in an orthotic boot. The whole idea of the boot is that — properly fitted and adjusted and used — it does the job of a healthy AT, while your AT can’t do that job. If you’re limping in it, it’s either not properly fitted or adjusted or used.