2 Shoes for the Outlier!

I am in two shoes now (in safe indoor environments).

After one week of PT, I am now cleared for wearing two shoes at home and other safe, indoor environments. Indeed, it is simultaneously exciting and terrifying! I am acutely aware of the environment when walking - even at home (especially my 9 and 6 year old children running around).

For others in earlier stages, be encouraged! You will see in my history below that I spent a long time (3 months) locked up in a cast. But, I have made progress. My incision is all healed and I was able to get into shoes after a week of PT. I have been able to walk with a pretty good gait and heal-to-toe motion.

Here is my PT status
1. Still doing all the therapeutic stretching stuff (see my previous post and others’).

2. Added exercises include:
• Balancing on my injured leg
• Balance on injured leg and tap healthy leg in front, side, and behind me
• Step throughs
• “Obstacle course” - walking through flat ladder on the floor
• “Obstacle course - stepping over small hurdles

Milestone Update
Here is an update to my milestone list.
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
Week 16: Started wearing 2 shoes indoors in safe environments

10 Responses to “2 Shoes for the Outlier!”

  1. YAY you! Do you find that you can wear your old shoes? I’m curious as to when the heel sensitivity goes away.

    I’m glad you keep posting, despite, what I sometimes see as zealousness regarding fast non-op being best ,that in my view has bordered on bullying at times. Evidence based doesn’t mean crap to me and I am a highly educated woman who taught high school/ college science for over twenty years. There are many more variables than data to be used in what is best for each individual and not all doctors think they are Gods, many do care about us and do know what they are doing. I applaud your commitment to follow your Doctors plan. It’s not us against them. I’m glad you have had a good recovery, may you have continued progress as you walk forward.

  2. Compared to me, I had ATR (total - there was like 1/2 in. gap) in Aug 2014 and now 80% recovery, all with SELF TREATMENT !!! I spent less than $100 for braces, crutches(did not use) etc. No doctor or PT at all! Did some exercises based on internet websites. Walking with braces 3 weeks after ATR. Went to gym, on treadmill and other weights @ 3 months. After 4 months, I started playing badminton again (which is when I had my ATR), even though I don’t have full retrieving ability but hey I miss the game! I think non-surgery is the best way to go in most cases, a testament to our amazing NATURAL power of healing. BTW I’m 53, not young and yet I could recover without ever seeing a doctor or PT.

  3. op or non op, fast or slow protocols… whatever you feel is best for you, is best for you. I personally believe that what we believe greatly effects outcomes. Whether the belief is true or not is often irrelevant. (As an aside there is good EB research on the effects of belief on outcome). Some will educate themselves to decide on how to treat their injury, others won’t…people are going to do what hey are going to do. GOOD evidence based anything is great and it most certainly serves,but it’s not all good and the jury is still out on many of the specifics and variables of op vs non-op, not to mention that the good evidence based medicine now out there in implementation is lacking. More good studies are needed and hopefully will be forthcoming…however, in the end we are all going to do what we are going to do based on so many different and varied variables. What works for me, despite the evidence, may not work for you and visa verse. Individuality can not be dismissed. It’s not always about EB practice but about personal needs. You are both clearly happy with your chosen routes…YAY you. I’m happy with mine. Big smile.

  4. CTCB, it sounds great. In fact, my reading of the post-op evidence is that going slow post-op does NOT lead to significantly worse outcomes - as opposed to going slow non-op, which clearly does. And you’ve clearly stayed sane (and kept custody of your kids!) through the long ordeal, so keep it up! :-)

    Donna, it’s probably very good that we’re both hanging around here, to give a balanced view. But I think you’re making me more moderate, and I’m making you more extreme, no? Anti-evidence? Because there are too many variables? Give your head a shake!

    I think many Docs are probably personally insecure, and have nightmares where they’re in a big final exam and realize they’re naked, or at least unprepared. They know they’re not Gods, though some of they’re patients can only stay sane by worshipping them. I spent a few years in an academic department where the senior faculty thought I could walk on water, and it made me very nervous! It had advantages too, but it’s not all roses.

    @BadmintonPlayer, you may want to read my blog tale of my 1-month setback from doing too much too soon, as a cautionary tale. Keep up the terrific progress, but Watch Your Step, too!

  5. I think it’s good to follow the evidence wherever it leads. I think in the case of ATR there are other considerations that come into play but given that there’s been studies that number in the thousands of people I think it’s fair to say that’s pretty solid evidence.

    I would venture to say your happy b/c of the outcome, which you couldn’t have known before you picked it. What if you got an infection, or had nerve damage? These are both possibilities but how could anyone know upfront? How could you know that you might have reruptured 1 year later due to a slow non-op protocol or a poor surgical outcome?

    The thing is, hindsight makes us all geniuses :)

    Going op or non-op, either way, is perfectly reasonable for most people based on the evidence available which is pretty solid IMO. I don’t think there’s enough to poo poo surgery totally, totally rationale decision at the time in probably most cases.

    Fast non-op has strong, strong evidence…I think ignoring evidence is dangerous, I mean it’s like the people who withhold treatment for their children b/c of a religious belief. Sure, maybe that’s what is best for them but based on the evidence it’s rather ludicrous (and criminal IMO)

    I think it’s probably not the wisest decision to walk on a ATR right away in a boot, it’s not wise to walk on it after surgery straight away..even if someone thinks that’s what’s best for them, we have evidence that this is foolish.

    I don’t get ignoring evidence due to personal belief, easy in hindsight when it turns out to be beneficial. On the other hand, totally important that you feel good about your choice upfront..that’s big in my opinion. That doesn’t mean making a decision in the face of solid evidence is reasonable though. With ATR’s, I don’t think there is a dead simple answer to most cases….but to just throw out evidence and use personal belief as a substitute in a medical and/or scientific setting I think it’s a tad dangerous. Again, don’t think that applies to any of our ATR decisions here…just in general.

  6. Why Norm I didn’t mention anyone in particular, why did you think I was talking about you? I wasn’t. I find you excited to educate, sometimes zealous yes, but I don’t have a problem with it because I believe you have good intentions and are very well meaning,it’s the bully’s here I don’t care for and I don’t need to name them. I am not anti evidence, I’m anti good consensual evidence. “Give my head a shake”…I find the personal attack insulting and below you. You misunderstand what I mean by variables, however, it’s not important. I often ask myself, “Do I want to be right, or happy”. I take happy, it works for me. I’ll stop hijacking CTCB’s post and cease and desist now. I’ll leave the “debating” to those of you who enjoy it.

  7. Eric…you said “but to just throw out evidence and use personal belief as a substitute in a medical and/or scientific setting I think it’s a tad dangerous. Again, don’t think that applies to any of our ATR decisions here…just in general.” You misunderstood me.

    What you said here is what I meant: “On the other hand, totally important that you feel good about your choice upfront..that’s big in my opinion. That doesn’t mean making a decision in the face of solid evidence is reasonable though.”

    This is the problem with written communication, clarification is difficult.

    As I said, enough said. Peace out.

  8. Sounds great CTC, I’ve at least found that I’m still (having been 6 weeks in two shoes out of any real “protection”) highly aware of my environment. I travel a lot for work, and at airports especially I find myself checking behind me in ques etc, certainly more than usual.

    On the discussion otherwise, considering that CTC has gone through surgery and then the long form of recovery, I didn’t think there was that much to complain about that. As far as I know the slow protocols post-op aren’t really harmful in the medical sense, but obviously it’s more challenging from the quality of life perspective and how quickly you recover, but it evens out in the longer term to a full recovery. This is obviously very different to the slow non-op protocols that have been shown to produce inferior results.

    Finally, saying “evidence based doesn’t mean crap to me”, I can’t really comprehend (I’m hoping that I misunderstand that somehow). Sure, there are a lot of factors and everyone is an individual, but surely one should go with the protocols that have been proven statistically to produce the best results, as it is impossible to know in advance what is the right solution for each individual. And if given the evidence, shouldn’t everyone feel the most comfortable with the best solution (whether that is surgery or modern non-op, I don’t think there is much evidence to distinguish between those two)?

  9. Wow! This is the first time checking back after my post and seeing the conversation.

    @Donna: Surprisingly, my old Nike’s are working out ok so far.

    Others: I am reluctant to wade too far into the treatment debate. But, I will opine a bit. My impression is that the average poster to this board is well educated and accomplished in their profession. I have found that educated people can easily carry the confidence they have in their field to other topics and assert strong opinions. I think that everyone should be cautious about overly advising and advocating for any course of treatment on this board or other similar sites. Clinical studies are invaluable and certainly oft cited on this site. But, a clinical study, by definition, is performed under controlled circumstances. Actual treatment involves other factors including the capability of the physician, patient compliance with treatment, insurance payment policies, patient condition, and others. In the US, the Affordable Care Act created the Patient-Centered Outcomes Research Institute (http://www.pcori.org/about-us) to focus on Comparative Effectiveness Research and to “provide information about which approaches to care might work best, given their PARTICULAR concerns, circumstances, and preferences”. Similarly, a success for one of us is a single data point that may or may not apply to another. Put simply, neither clinical studies nor personal experience are sufficient for advising treatment for a person over the Internet.

    By the time most people find this website, we are already on a path. I think the most valuable thing is to describe our experience with our chosen (or imposed) path and to encourage.

  10. CTC

    Looking back at many posts on Achillesblog brings me to the conclusion that most of us aren’t especially ‘advocating’ as such - what we are doing, sometimes very enthusiastically, is (as you suggest) describing our experiences, telling of the ‘new stuff’ that we may have come across, passed on some tips, and, yes, given support. Even Norm, doyen of these pages, was virtually castigated a few days back - he can be irritating and very wordy, but is mostly dead right, progressive and very supportive.

    What really does irritate some people is when those who have had a good treatment ‘journey’ bang on about it. They shouldn’t be annoyed, they should get the good info and take it to their medics and ask if they’ve seen it too. Who knows, even partway through your rehab schedule, you may have the opportunity to make a positive deviation from the rout you were on.

    Good luck

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