Left footed driving and other tips for a long casted period

December 28, 2014

I am writing to share a few tips based on my experience of being in a cast for 3 months post op after an AT rupture. It has been a challenge and I know others may struggle with casts no matter the time period. My good news is that I am FWB and walking at a good pace and normal gait now in a fiberglass cast. I am also just 2 days away from getting this cast removed.

Left foot accelerator
I injured my right leg and grew tired of a long, draining commute to work with cabs, shuttles, and commuter trains that turned a one hour drive into a 2.5 hour odyssey. I discovered and rented a left foot accelerator device that is common for the permanently disabled. I switched cars with my wife since I drive a 5 speed manual transmission and the devices only work with automatic transmission. If you go down this path, I first recommend that you check with your local transportation authority (e.g., Department of Motor Vehicles) to make sure it is legal. Second, start with very safe, small tests. I started with a parking lot drive, graduated to a quiet neighborhood street, and then tested highway driving with light traffic conditions. Third, find the right shoe to use with the accelerator. I have an Even Up on my healthy leg and found that it inhibited my feel for the pedal. I wear a flat shoe for driving that lets me manipulate the pedal better. Finally, you may need to be a gentler driver than normal. I drive slower and leave more space for the cars in front of me.

Here is a video of how the driving works with one of these devices: https://www.youtube.com/watch?v=vnulcp8CnLs

Here is the product I rented: http://www.plfa.org/

Other Products
Here are the other products I have used. Many of these are obvious and already accounted for in the “Things you may need” section. But, there might be a few helpful hints here.

1. Iwalk: A crutch alternative was a life saver. It let me use both hands and do everyday activities. I used it everywhere including home, trains, and the office. Just be prepared for a few odd looks and a lot of people stopping you to talk about it.
2. Crutches. You can’t get away from them! Even if you use a scooter or other crutch alternative during NWB, you will likely need crutches to start PWB and progress to FWB.
3. Cane. I used a cane for a day and a half right before going FWB. It might have been mental, but it helped me get to point of being hands free and FWB.
4. Even Up. The multiple recommendations on this site are true. Do something to avoid being a “weeble wobble” and unbalanced. Even Ups worked well for me as the walking cast and cast shoe were very thick and raised my injured side significantly higher than my healthy side.
5. Boot. Clearly, I am not a boot expert since I have been in a cast for so long. But, I do have one ready to use as necessary in my next stage.
6. Baby Wipes. Baby wipes are useful for cleaning your exposed toes at the end of the cast.
7. Cast Cover. When I was ready to take a real shower, the cast cover was great. It kept the cast completely dry. I only had trouble recently (a rip in the top) after using it for a long time.
8. Trash Bags. When the cast cover broke, I reverted to trash bags to take a shower.
9. Painter’s Tape. I found that blue painter’s tape was effective for sealing the trash bags and broken cast cover without ripping off too much skin.
10. Shower and bathroom mats. To avoid slipping and putting unplanned/improper pressure on the injured side
11. Shower chair. Sitting down during a shower is a unique experience!
12. Urinal. A ruptured achilles, or another lower body injury, is a desperate time. I used a urinal as a desperate measure. It helped me avoid those midnight falling issues that can occur getting to the bathroom.
13. Compression Socks. I wore compressions socks most of the time on my healthy leg for protection. My ankle, achilles, and calf on my good side grew very fatigued and I did not want an additional problem. The compression sock felt like it provided some extra stability and relief.
14. Ice and heating pad. I alternated ice and heat therapy on my good Achilles and calf and it started to fatigue in the darkest days of NWB.

Hope some of this is helpful.


FWB in a Cast

December 8, 2014

I am now full weight bearing in a walking cast. As a reminder, I am on the slower end of a post operation recovery (8 weeks NWB and then put into a walking cast).

After starting partial weight bearing, I spent about 2.5 weeks using two crutches, a deliberate heal-to-toe motion, and applying more pressure every three to four days. For one day, I used a cane as a bridge between PWB and true FWB. I found the cane helpful to get over the mental hurdle and to make sure I could balance myself properly.

At this stage, I am sure a boot would have been more comfortable because walking in a fiberglass cast is a hassle and not very comfortable. My technique is to: (a) lead with my injured leg; (b) use a heal-to-toe motion; and (c) then to bring my healthy foot even or slightly ahead of my injured leg. Now, I will be FWB until December 30th, which will be a joyous end to three months in a cast after surgery.

Happy healing to all!


PWB: Walking Cast at 8 Weeks Post Op

November 22, 2014

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.


Reflections: Long NWB Period

November 8, 2014

I am now 10 days away from getting my cast off!  This will conclude 8 weeks of NWB (2 weeks in a splint post-op and 6 weeks in a cast). I’d like to share some reflections for others on a similar path.

The physical challenge
6 to 8 weeks non weight bearing takes a toll on the rest of your body. I used traditional crutches for 3 weeks and an I-walk for 5 weeks. My uninjured leg is very tired and sore.  Here is what I did and learned:

  • Limit hopping: In the beginning, I hopped around a lot on my good leg because it seemed easier than getting the crutches.  But, over time, this made my good foot extremely sore.  I needed to slow down and stop the hopping around to survive the 8 weeks.
  • Protect the other calf and achillees: At one point, I was concerned that I might hurt my other achilles or ankle.  I found that I needed to wear shoes with a thick sole at all times to even myself up to the Iwalk and avoid getting on my tippy toes with my good foot.  I also ice down my good foot and Achilles area regularly to manage the soreness.
  • Technique: I have been focusing on using the right technique (initially with crutches and now with the iwalk) to avoid falls.  There are numerous examples of re-injuries because of slips and falls.  De-clutter your surroundings, be careful around crowds, and use whatever assistive device you have the right way, every time.

The mental challenge. The mental and emotional challenge is huge.  Walking is a fundamental human activity and not being able to do it can be devastating.  Additionally, I am typically very active with exercise, sports, and my children - making the sudden disability even harder to handle.  I created two themes for myself to endure  . . .

  • Patience. Anxiety can cause us to do something stupid and experience a set back.  I am convinced that years from now I will look back on this and it will make for a good story and seem less significant than now.  Everyday I tell myself that patience will let my body heal and recover.
  • Contentment. We cannot change the past absent a time machine.  So, I tell myself to forget the past, be content in this temporary state, and to ready myself for PWB/FWB and PT.

I hope this helps someone.


Non Weight Bearing Implementation

October 29, 2014

How exactly did people with successful recoveries implement NWB?

I am halfway through a 6 week NWB phase. I have been able to avoid putting my foot down to bear my body weight (no falls, accidents, etc). However, I just saw some clinical articles that define NWB as absolutely NEVER putting the foot on the floor. When sitting, I gently rest my heel on the floor with my toes pointed up - especially at work. Your experience?


Slow and methododical

October 25, 2014

Hi All,

I am starting my blog 4 weeks after my surgery.  I’d like to share my experience with a slow, methodical recovery since I have read so much about newer and faster recovery protocols.  While I would love a fast recovery, it is just not in the cards for me and I am sure others are in the same situation.  Hopefully, I can meet others on a timeline like mine so that we can encourage each other!

Here is a summary of my experience to date.

ABOUT ME: I am a 42 year old guy.  I am in ok shape, but not running marathons!  A week before my injury, I ran a 5K in 26 minutes.

INJURY: Playing soccer  in the "over and 40" league.  My story is the same as others - nobody touched me, heard the pop, everything went numb, lots of pain, etc.  I’ve had a good array of injuries and this is by far the most painful I have experienced.

DIAGNOSIS : An urgent care clinic misdiagnosed me as having a mild sprain the next day.  I visited an ortho. specialist 6 days later who diagnosed a complete rupture and scheduled me for surgery.  My surgery was 13 days after the injury.

PRE-SURGERY: I have two Pre-Op suggestions.  First,  ask your doctor about Hibiclens as a pre-surgery wash.  My doctor instructed me to use this the night before and morning of surgery to disinfect the skin and reduce the chances of infection (http://www.hibiclens.com/retail ).  Second, learn how to use crutches before your surgery if you have never used them before.  In the US, this is typically an outpatient procedure and my surgeon’s communication skills were mediocre, at best, and he did not explain clearly how I would feel.  I was thankful that I already knew how to use crutches from prior injuries because the outpatient surgery center discharged me within a hour of waking up and I was still very groggy.  Getting into your house under these conditions is not the time to learn crutches.

SURGERY: The surgery went as expected.  However, see the caution above about the fast discharge.

FIRST TWO WEEKS: Like others, I was essentially on bed rest the first two weeks with a splint on my leg.  I generally felt lousy.  I had electricity-like, pins and needles feelings along the incision and just could never get comfortable. I used the pain killers so I could get restorative, healing sleep.

FIRST APPOINTMENT: In my first follow up appointment, the doctor removed the staples and sutures and cleaned the incision area.  I found this all very uncomfortable as I did not want anyone touching me!  I thank God that the incision was healing well.

RECOVERY PROTOCOL: I am the opposite of others that have one of these fast recovery protocols.  I caused a nice chuckle when I asked about a walking boot in my first follow up appointment.  They said my rupture was too severe for anything like that.

  • 6 weeks: non-weight bearing cast
  • 6 weeks: slowly start to bear weight in a walking cast

My attitude is to be a compliant patient and simply do what the doctor told me to do.  My goal is to return to the same level of fitness and to be healthy and strong enough to play soccer again.  But,  I am finished with actually playing basketball/soccer types of sprinting sports.  I’ll stick to more boring exercise routines.  I don’t need anything like this again. So, I’ll deal with a few extra weeks of hobbling around to get there.  I know I will experience some additional atrophy.  But, muscles can eventually be strengthened.

NOW:

  • I am using the I-Walk instead of crutches.  While this is not as easy as the company marketing materials make it appear, it works much better for me than old school crutches.  I considered a roller.  But, I live in Washington, DC and need to navigate lots of stairs.
  • My pain is much more tolerable than a month ago.  Towards the end of the day, my fiberglass cast just starts to make everything hurt.  In the evenings, the area along the incision gets irritated with the "electrical" feelings.  I am down to taking a Tylenol or two before bed so that I can get to sleep.
  • It is hard to judge how well I am healing since I am not putting my foot down.  However, my toes are one indication.  In the beginning, moving my toes or having my toes touched felt terrible.  I could literally feel the achilles tendon move and it hurt terribly. Now, I can wiggle my toes around without pain.
  • Every other part of my body is sore.  My good legs hurts.  My arms hurt.  Everything.  It’s a pain.
  • I am sleeping in heaps.  Between my body needing the sleep to heal and being worn out from getting around, I go to bed at the same time as my 9 and 6 year olds.