PWB: Walking Cast at 8 Weeks Post Op

I am now partial weight bearing in a fiberglass walking cast. To recap, I had 8 weeks of NWB after surgery for a complete rupture (2 weeks in a splint and 6 weeks NWB in a cast).

My skin looked good considering the long time frame. My incision was healing well.  The OS said the tendon looked good after an MRI and his examination. I had a decent range of motion and could move my ankle in a complete circle in both directions.

The doctor put me in a walking cast instead of a boot.  He said he uses walking casts at this stage instead of boots. The walking cast is much thicker than a NWB cast and more of my toes are exposed. I will be in this cast for another 6 weeks until New Year’s Eve. After that, I will be in a boot and cleared for PT.

Here is the progressive weight bearing plan he gave me:
1.  Day 1 through 4: 30 pounds of weight on injured leg
2.  Day 4 through 8: 60 pounds
3.  Day 8 through 10: 90 pounds
4.  Day 10 through 12: 120 pounds
5.  Approx two weeks: FWB without crutches

I use a bathroom scale to get the feel of each amount of weight. So far, I am using two crutches and doing an exaggerated heal-to-toe motion. On my healthy leg, I am wearing thick-soled shoes, an Even Up, and a compression sock plus thick socks to avoid another injury.

I am thrilled to be out of my long NWB phase. As others have described, it is indeed thrilling to reach a milestone and to start walking again. While I cannot do PT yet, I am cleared to ride a stationary bike, which I will try in a few weeks.

Best wishes and healing to all.

18 Responses to “PWB: Walking Cast at 8 Weeks Post Op”

  1. Glad you are moving towards FWB- I started using a stationary bike at 4 weeks and have found it to be a great help!
    Good luck…..

  2. Bloody slow, glad you’re savoring the milestones! The OS who repaired my first ATR (8 years before the second, on the other side) described himself as “very conservative” and put me in a long series of casts, the later ones heavy fiberglass walking casts. Eventually, I talked him into putting me into a (Donjoy hinged) boot, and I became the first patient of his who had ever gotten a boot. The case for going slow back then (2001-2) was stronger than it is now, when so many brilliantly successful fast-rehab studies have been published. And BTW, ALL the published studies restricted their patients to those with FULL ruptures, at least according to the Thomson Test.
    Good luck, and good healing.

  3. Hey Busted, what is going on here?

    Give yourself a great Thanksgiving gift and get your OS to confirm that you have misunderstood the timeline. By New Year, unless there has been some complication, you truly should be in 2 shoes, (driving, if you do), and doing ever more exercise. Or maybe not if your calf has atrophied just too much, ankle weak, and more - and how is your good leg bearing up? Or have you managed to maintain an evenness on both sides therefore saving wear and tear on the good side?

    Good luck pal

  4. Norm and ATRBuff:

    I understood the timeline correctly. Perhaps I am not smart enough to do what you gentlemen recommend. But, I cannot think of an effective way to argue down the head of orthopedics from Georgetown University who also teaches in the med school and averages at least 30 ATR surgeries per year. So, in lieu of obtaining sufficient clinical knowledge to win such a debate, I don’t have much choice except to enjoy walking and just get ready for PT right after Christmas.

  5. Ctc - If you are comfortable with the treatment you are getting then I can tell you all will be good in the long term. You will probably suffer a few more aches and pains in other joints for a while due to the prolonged immobilization but in 2 years you will be where everyone else is in 2 years. It is more of an uneccessary pain in the early period of this rehab and contributes more to quality of life for surgical patients. I can understand exactly how you feel about butting heads with your surgeon. I stopped going to mine with my current tendon injury because he did not like to be questioned. I should say he did not like me asking questions either. I think it cut into his patient/hour average too much. It is a shame such learned people can be so stuck in their thinking. No doubt if you asked him why he did it this way he would say it is because that is the way he has always done it and it works. Anyway you are certainly much more patient than me and that is a good thing when it comes to getting throught this. Keep us up to date with how you are going.

  6. CTCB, I have no needs, requirements, or demands here, and I know it’s not my leg. So if you’re happy I’m happy. The one time I went super-slow (post-op, ATR #1), my injured-side knee started blowing out shortly before I became FWB, presumably because I had spent so much time kneeling on it, Try not to go THAT slow.

  7. Busted

    I don’t know if you’re cross about our feedback or frustrated, or both.

    Truth of the matter is that the blog rightly attracts a diverse range of comments, that’s what it’s all about, and it is one of the best ways to let the world know what is out there, even establishing benchmarks around what you can expect at a time when most of us had zero experience of an atr.

    As it stands though, and most would agree, if you are comfortable with where you are, great.

  8. ATRbuff,

    No, I am not cross about the feedback. I know that is a benefit of this site - to understand the wide variety of treatments we all receive. So, I appreciate the perspective. But, it is frustrating to think of a realistic way to change the path I am on. I really was not able to change the surgeon’s opinion. Since his is also a professor, he knows about the oft-cited studies mentioned on this site plus additional other clinical and comparative effectiveness research that does not get cited in this web site. I also not inclined to go searching for a doctor that will give me an answer that I want.

  9. I completely understand your position. Not many laymen would take on the expert and win, and he is as convinced about his opinion as we are ours. What would be great is if we could see some of the reports that are so pro-op, and from the last 3 or 4 years max.

    Patience is going to be key, and good quality physio as soon as you can start it. The extra deterioration that you be suffering can be made up in a few months, and by 12 months you’ll be pretty much back to normal.

    All the best

    Buffy

  10. Hello CT!
    I am on a slow process as well and very comfortable in this slow process. For example, I slipped yesterday whileon crutches as the floor was wet, and my fibercast protected my injured leg. Of course it hurt a bit, but nothing to worry about. At the end of the day, as long as we are ok with the battle plan established, it’s all good!!!
    ciao

  11. I love this exchange, and CTC I’m especially delighted that you are taking all the comments - including my blunt ones - in the spirit they’re given. :-)
    It may be worth mentioning that I can really see both sides here, despite my strong preference for (what I see as) the evidence-based approach. I’ve had 2 ATRs myself, right leg op end of 2001, left leg non-op end of 2009. My first OS called himself Very Conservative, and he/we went ultra-slow. Maybe THREE casts (plaster, fiberglass, fiberglass), the I FINALLY got into a boot. I TRIED to change his approach, and I did a little - his first booted patient ever - but he was always in charge of my leg, and in hindsight all the effects of my strong complaints - during the widely spaced 10-minute periods when he deigned to descend from Mount Sinai and speak to me - were pretty puny.
    Eight years later, I MIGHT have been a real expert on the evidence, op vs. non-op, fast protocols, etc… but I wasn’t. It was my second OS who had “gotten the memo”, not me! He had attended AAOS 2009 in the US, and had met with the authors of the still-unpublished UWO study (from back here in Ontario Canaxa!). As a result, he quit doing surgical ATR repairs, cold turkey! So he convinced me, and my became the compliant Patient from Heaven, following the instructions of my omniscient God-like OS.
    One other point: I’ve been a professor at two excellent universities, and I’ve known lots more. If you think that status means that they’re all up to speed on all the research done in every corner of their field, you’re way wrong. First, there’s too much, and second, there’s too much work and too few hours. And I wasn’t a prof AND a clinical surgeon and maybe a hospital (and/or university) administrator too. You should also know that most surgeons do surgeries that are much more exciting, important, and “sexy” than ATR repairs, which are often called “the tonsillectomy of the leg”. These guys think they were able to do this blindfolded when they were young, and many of them aren’t open to learning new tricks, especially from a patient. A funny old BMJ article refers to this as Eminence Based Medicine, and lots of people here have encountered it, and coped in different ways.
    If your OS Prof really does have some research that justifies his ways, (a) somebody should publish it, for the benefit of the many, and (b) you could probably find out if it really exists and what it consists of, without threatening his ego or your Doc-patient relationship, and share it with us who care about ATR research.

  12. Nico, another satisfied customer, and good to see that your cast protected your leg. The new fiber casts are great, so much lighter and a choice of color too. Definitely bearable for a short while, and better than the old heavy types, and going then into a boot meant no serial recasting every 2 weeks.

    For those of you in a boot, however slow or fast your protocol, be assured that if it is fitted correctly, it too will handle its protective duties well, and get you away from crutches within a month. I kept mine handy for an extra week or two for uneven ground.

  13. Nick, through my glasses, I see somebody who sustained a minor insult to a healing AT in a crutch slip, when he should have just walked over that wet spot in a boot FWB! Same facts, different lenses… Keep healing, keep watching your steps, and good luck to all.

  14. I typed Nico, but my phone didn’t believe it, sorry!

  15. Norm: I agree and have no misconceptions that being a professor means that he is keeping up with the evolving field. I actually bought up his status within the university to indicate that he won’t hear a thing from a lay person.

  16. Norm (or anyone else). The evidence on the non-op low reruptures with the faster protocols seems solid, but wondering about the other oft cited benefit of surgery vs non-op, namely the permanent loss of jumping strength (I’ve normally seen this presented as 20-30%) in non-op, vs full recovery to normal in surgical fixes. I think the original view comes from studies with the “old” non-op protocols, have the later ones assessed this as well?

  17. Noted and thanks and I don’t disagree, ct busted.
    @gravity, there’s a strong qualitative rebuttal of that fear in Wallace’s study, especially his reported 100% return to sport among all the sporting patients in his ~1000 non-op patients. The most careful quantitative comparison of strength and ROM in a randomized trial is in the UWO study. In ~150 patients, half each treatment (all full ATRs), they measured many categories at 2 or 3 time intervals, and the differences were statistically insignificant except in one measure, IIRC. So nothing close to a 30% difference in strength. BUT, if you look at the graphs of the raw data, you will see that their post-op patients were generally a bit stronger in the tests than the non-op ones - not enough to be stat-sig in a sample that size, but not identical.
    Nobody’s done a RCT like UWO with Wallace’s non-op technique yet, I wish somebody would.
    One more footnote about stats (which I’ve studied, but not a real hotshot): UWO and other RCTs measured strength. If they had instead measured strength DIFFERENCE (between each patient’s 2 legs), I’m guessing that some of their insignificant strength discrepancies (between op and non-op) might have been stat-sig!

  18. Nobody’s ever been fired, jailed, or sued for repeating “oft-cited” medical falsehoods. Pity! And some of these myths used to be true, when non-op treatment was slow and “conservative” and had poor results.

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