Start of weeks 4-6 (Non-Op)

I went for my 4 week check-up today and was a bit disappointed.  I was in a splint / cast for the first two weeks NWB on crutches. Start of week three I was placed in Air Cast with crutches and told NWB.  After a 5 days I was PWB. Few more days FWB with the aid of a cane.  Then many time without cane.  All with no pain or discomfort.  I also removed the aircast for showers and sleeping.  I was aided in taking these steps by the many posts I read here that I was not doing my ATR harm.

At today’s exam I was informed all was going well and my Orthopedic Surgeon wanted me to strictly adhere to the Canadian protocol for weeks 4-6.  Namely remain in the Air Cast boot, keep the heel pad in, use crutches and keep the boot on at all times even sleeping.   I told my doctor (who by the way is the head of foot and ankle div of major teaching hospital here in Boston as well as asst. professor at Harvard Medical School so he is ‘UP” on all these studies) that I had progressed beyond the 2-4 week pace of the study (E.g. FWB, cane, no boot for sleeping and showers).  He acknowledged my progress but wanted to adhere to the exact protocol for the 4-6 week period, PWB, crutches, keeping the boot on at all times.   As I said I was some what disappointed. I thought I would at the vey least have the heel pad removed and stay in the boot.  

My question is this.  I know that I will still use a cane, stay FWB (as this doesn’t hurt at all) and remove the boot for sleeping and showering but is there something that I can do during the two week period before my next appointment ?  I do sit with my leg raised and the boot off and do some ‘alphabet tracing’ with my toes and move my foot around.   I have not tried to walk sans boot yet, though I can stand with boot of cane, equal weight on both feet with no discomfort.    Having said all that is there something I might do to aid in my recovery that might be ‘outside’ the protocol for this 4-6 period.  Thanks

16 Responses to “Start of weeks 4-6 (Non-Op)”

  1. Whats the rush? I’d play it safe, whats 2-3 extra weeks if you have to start from scratch?

    I havent worn a boot since I left my 1 week post op; mainly because I havent moved and just kept my foot elevated.

    Its great to hear that youve been able to walk so early but i’d be careful. After I ruptured they told me I could walk with the boot before the surgery. Well two days later and I almost had a bunion. Reality is the achilles & other muscles arent strong enough and your foot will bear the majority of the load and may give you other problems.

    Good luck….sleeping with a boot seems insane; as does a boot when you have it elevated as youre doing nothing except elevating. Last night I woke myself because my foot was convulsing or something but the boot at noght seems a stretch.

  2. Hi I am also non-op at 17 weeks and following the Cdn protocol. I say be patient and follow the protocol as long as you can. I have had great success with my ATR recovery and most of that is because I stuck with the protocol and wore the boot, slowly weaning off the wedges from 8 weeks and gradually and safely walking around at home from 7 or so weeks on. I was to be weaned out of the boot by 12 weeks but I got out of it fully by 10 weeks. I was getting impatient and had a couple of scary bad steps that luckily didn’ t injure me. It was enough to realize at 6 weeks I was still weak.
    I have been religious about physio and working out and I am happy to report that I am now running and jumping ( controlled , 2 footed) and have returned
    to almost normal exercise (bootcamp) routines. I still have work to do but I feel I was both diligent in following the protocol and lucky I didn’t have any accidents or falls along the way. I fully advocate the non-operative approach to recover from this injury!!

  3. I have been sleeping without the boot for 10 days or so with no issues. I also have been putting full weight some times again with no issues. I have taken just a few steps with the boot to measure just how weak the achilles is and it IS weak. Other than the removal of the boot at night and the FWB without crutches (which I have dumped in favor of a cane) I am following the Canadian Protocol as outlined by my Otho Dr.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  4. I was a little confused on your post. Did you say you got out of the boot in 7 weeks or that you were still in the boot with the heel wedges removed. The wedge I have is only one and it is maybe a 1/2 inch at its peak. I saw some posts that said they had a 2 inch wedge is that possible ?

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  5. At 7 weeks i was still in the boot with 2 wedges in. Initially I had 3 x 0.5 inch. Wedges and they came out one at a time at week 6, 8, 10 and I was to be out of the boot fully by week 12. That was the protocol called for.

    And I started walking around slowly, carefully in wedge clog shoes from week 7 onwards gradually increasing time out of the boot at home. I also used the cane. Physio also had me out if the boot for treatment. The walking was going so well that by week 10 I felt like I could manage without the boot.
    My advice is take your time walking without the boot until you feel more solid it was more limping and shuffling initially and my shoes were heels of the
    same height as my boot was at so the Achilles didn’t over stretch. Also if your house is risky- pets, kids, toys, stairs like mine is be extra vigilant ESP at night if you are bootless. Best wishes.

  6. I’ve posted the “Canadian protocol” at bit.ly/UWOProtocol , and I think you can also get the official published version by finding the study among the others (from the Main Page here), then clicking at the link at the bottom. They’re virtually identical — my version was the one the authors faxed to my Doc after they delivered their results as an AAOS2009 paper, but before they published it in 2010.

    Either way, you get to “FWB as tolerated” at FOUR weeks, the wedges come out at SIX weeks, and you “wean” off the boot at EIGHT. (Your docs seem to be making you go slower, which is NOT how the UWO/Canadian study got their good results!) The exercise schedule is there, too, for you to follow.

    If you’re not sure about the meaning of the exercises, you should probably take it easier, but going slower on FWB and wedge removal doesn’t seem especially “conservative” or extra-safe to me, FWIW.

  7. It’s always best to follow your doctor’s orders… but don’t hesitate to ask that doctor a million questions! Specificity is the key when healing an injury as complex as a full ATR.

    I learned during my first healing process (non-op) that I shouldn’t have been taking any anti-inflammatory drugs and after a second rupture two weeks into walking (2 shoes) I learned that smoking is highly detrimental to the healing of such an avascular area.

    After my third rupture in one year, I realized anything I want to do pretty much requires hassling my doctors for information, especially since surgeons have the tendency to be so distant.

  8. Rosethorn, did you rupture and twice re-rupture the same AT? (Yikes!)

    Deciding how slavishly to follow our Docs is one of the trickiest things we do, maybe esp in this injury. OT1H, being “bad” can easily lead to reinjury or healing long, etc. OTOH, this is an area of medicine that gets little respect from most Ortho Surgeons, and where “Eminence Based Medicine” (you’ll do what I say because I’m the boss!) often takes precedence over Evidence-Based Medicine. We’ve had a few cases here where well-informed patients have changed the ATR-treatment practice of their Docs, and (at least once) of an entire hospital!

    Virtually all doctors mean well, but a full 50% of them graduated in the bottom half of their class. (Naturally, that’s never the Doc who treats US, right?!?)

  9. Norm, that reminds of another truth… Practicing somewhere in the world: is the worlds worst dentist. :-)

  10. I have no idea how to make a post other than leaving a reply, so if anyone can tell me, please do.

    I’m 3 1/2 weeks into recovery of a partial rupture, non-surgical recovery. I have pain on the upper part of the tendon, moreso what I think is the bottom of the soleus, maybe gastrocs. I think soleus though and perhaps more medially.

    Does anyone else experience the pain, tenderness, weakness on the lower end of the middle of the calf?

    I’ve been non-weight bearing this whole time. Started taking off boot mid-night due to major discomfort. Still icing, elevating, and doing dorsi/plantar flexion Guess I should start doing the alphabet too. The only hydrotherapy I get is a hot bath with epsom salts and moving my ankle back and forth in the water. Would like to get to a pool. Except, what am I to do - crawl in a swimsuit? Crutches on a wet, slick surface is NOT safe!!!

    I guess, I feel worried that there’s more damage in the muscle (of the soleus) than just the tendon. I did hear the big POP though. So did everyone else!

    I appreciate feedback.

    Thanks,
    Chantelle

  11. Hi all - I’ve been addicted to this website since I ruptured my achilles 2 weeks ago, and I wanted to start interacting with you all.

    My surgeon elected for non-operative treatment, and has told me to expect to be in the Aircast for 8weeks ish and then we’ll take it from there. He said I can FWB from as soon as I feel ready.

    In the first week this was just not possible AT ALL. But suddenly, hitting week 2, I began to PWB with crutches and now am feeling stronger.

    That said, I think I’m still coming to terms with everything and am suddenly on a massive low. I’m female, 21, and am so eager to regain my active lifestyle (as I know everyone is).

    I read on this site a blog of someone who was still in immense pain and struggling with walking at the 4month mark and it’s stayed with me all day.

    Is there anyone who has received non-operative management who is a year or so on and can vouch for what they think is an average timeline in weeks of when they were able to flex the heel, then have their boot off, then walking, then walking/running??

    I want to stay realistic and positive about this and not beat myself up too much!

    love to all

  12. ps. Hi Chantelle

    I think you’re about half a week ahead of me in your recovery.

    I too had really bad pain in my lower calf, I think due to incredible cramp. I mean, it was literally constant for the first two weeks and would reduce me to tears in the morning.

    Could this be what you’re feeling. Baths, tonic water and bananas all good cramp-fighters :) And i massage my injured leg’s calf every morning.

    Hope you feel better soon, keep in touch

    Lauren

  13. Greetings All,
    I am 2 weeks (tonight) into a partial tear, I went to our local clinic. (I don’t have insurance) and received a boot as well,
    but no instructions on therapy or anything. So this is a going to be a great resource for my healing process. have started taking glucosamine and vitamins and eating more protein.
    but how soon should i begin to do rehab of any such? thanks and best of luck to all! .
    Phil

  14. Hello all, Phil again

    Hey Chantelle, are you experiencing kinda like a burning
    tearing feeling? because I am feeling this as well. but the back of the ankle is feeling a little more stiff, but a good stiff.
    man, this is a bugger of an injury!

  15. I am 18 days post rupture and following the Cdn non-surgical treatment, recommended by Otho Surgeon. Not quite sure why, I’m 43 still active and run 12-15miles a week. What I’d like to know is does the non surgical treatment get me back on my feet and able to work nearly as quick as if I’d had surgery. I work three 12-hr shifts/week and am on my feet around 70% of the time. How many weeks out will it be before I can stay on my feet a majority of the day? How long before I can return to running? I’m now wondering if I shouldn’t have demanded to have a surgical repair.

  16. early march partial rupture, back on roller skates for 5 weeks, absolutely the best therapy there is. strength increases each week, doing front cross overs for two weeks now, but keeping it mellow

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