May 6th, 2013

So I am having serious anxiety about going to the doctor tomorrow. Last week having my foot shoved to 90 degrees was so painful and a set back in how I was feeling. I plan on eating and taking a pain pill before I go just in case, even though I havent taken one since last week.
So I have a few questions for all:

If you had casts following surgery, did they push you any farther than 90 degrees?

If I am already at 90 degrees, shouldn’t I start ROM exercises not in a cast, or even partial weight bearing?

How long does it take for the dissolving stitches on my incision to be gone/heal?

Thanks in advance :)

10 Responses to “Anxiety”

  1. Jack on May 6, 2013 11:21 PM

    Dana, I too was in a cast for almost 4 weeks, and it was set with the foot neutral (abouot a 25 / 30 degree downward flexion). When it came off and I went into the boot, I slowly started with the flexion exercises - I could almost bring the foot back to 90 degrees - it was tight but no pain. My suggestion to you would be what the Dr. said to the patient: “Doc - it hurts when I do this”. Doctor - “DON’T DO THAT”. I did have one scary moment about 4 or 5 days after the cast came off when I was ROM stretching and felt a small but sharp “TWINGE” in the tendon. Nothing like the initial injury, but enough to kick me and remind me to GO SLOW AND EASY! I’ve been in the boot for almost 4 weeks now and stretching is getting incredibally easier.

    My Dr. used the dissolving stitches on the graft he wrapped around the tendon, but used an adhesive to close up the incision - the adhesive came off when I washed my foot the day the cast came off as the incision had completely healed by then - 5 weeks after the surgery. I’m not familliar with dissolving stitches to close up an incision though.

  2. dana925 on May 6, 2013 11:47 PM

    Interesting. My foot was only pointed downward for the first week. 2nd week at 90 degrees. I know he told the nurse he didn’t think we would get it to 90 and she was happy that I did. You know, I never did ask about how they attached the graft, I just assumed it was stitched. And anchors. But I didn’t have a rupture, just degeneration of the tendon. (strange since I’m only 25). I hope it’s a good thing I’m already at 90. Hmmm. Guess I have some questions to ask tomorrow!

    I know it will be hard for me to take it easy once the cast is off. Pain will definitely be an indicator if I am doing too much for sure.

  3. normofthenorth on May 7, 2013 4:06 AM

    Me, I think that if an angle-change “stretch” is painful, it’s too soon. And if it feels great, it’s probably too late. One of the nice things about boots vs. casts is that you can play with these things. If removing a big wedge is too big a jump, try putting a small one back in, type thing. And hinged boots where you can dial in specific ankle angles are similar, maybe even better.

    I’ve never heard of anybody being casted or booted in a dorsiflexed position, more acute angle than 90 degrees aka neutral. A few people here (Hillie comes to mind) have had hinged boots set to move past neutral, but even that is rare.

    Jack, I think when you said “neutral” above, you probably meant “in gravity equinus”, i.e., where your foot hangs of its own weight. As you say, that’s 25-30 degrees doen, below what we usually call “neutral”.

  4. dana925 on May 7, 2013 9:40 AM

    It hurt. Bad. But hopefully today they won’t push it any farther. I don’t have any pain really at all unless I let it swell too much. And since I was so swollen when they put the cast on, and now I’m not, I can move a good amount in the hard cast without pain, actually feels good to move it. Hell, I’m just ready to shower without my leg out of the tub in hopes I don’t get the cast wet!

  5. hillie on May 7, 2013 1:25 PM

    Hi Dana

    Norm is correct with his reference to my protocol. I was non-op (full atr), but rehab programme was same for surgical cases. After week 8, as directed by my specialist, I adjusted my boot, which I had after week 2, to give a hingeing range of movement from 30º PF through 10º DF. This took a few hours to feel secure with and gave me a smooth transition into 2 shoes (with silicon heel pads) a week later (similar range of movement). At week 10 I was driving and able to increase exercise appreciably.

    My boot was a UK NHS-supplied VacoPed Achilles and we were simply making best use of the latest (and possibly safest) technology - we weren’t pushing past the limitations of the boot which would actually allow for another 5º DF movement.

  6. normofthenorth on May 7, 2013 4:50 PM

    BTW, my hinged boot was capable of hinge-ing quite far in the DF direction, and farther in the PF direction than either ankle can flex. I set it free to hinge from neutral to “infinite” PF, and walked very securely, fast, and comfortably in it after both ATRs. After I’d been doing that for a few days post-ATR#2 (starting at ~7 weeks in), I experimented with the hinge setting, letting it go 5 or 10 degrees into DF. My leg and I hated it (unlike Hillie and hers), so I put the stop back at neutral (aka 90 degrees or 0 degrees). Then I went into 2 shoes with NO heel wedges, a la UWO. OK transition, though I certainly walked asymmetrically for a while.
    Different strokes…

  7. normofthenorth on May 7, 2013 4:54 PM

    Dana, back to you! My only reason to mention the hinged boots was to reassure you that you will NOT be forced into a DF position in a cast — and to urge you to fight for a boot (preferably hinged, though non-hinged isn’t a deal-breaker).

  8. mikejp88 on May 7, 2013 5:44 PM

    If my surgeon had been doing that I’d probably run and never go back. Probably re-opened your healing tendon (the sutures may be intact).

  9. dana925 on May 7, 2013 9:15 PM

    Surprisingly, I was pretty strong when they took the cast off today. Able to point down and pull it back up to 90 degrees on my own without pain. Granted, I was pretty shaky, they said I’m doing great and were extremely happy with my progress so far. Another cast today at 90 degrees, and one more after this next Tuesday. Then I go into the boot. I did try to push for the boot today (I already have one from January when they tried to heal me without surgery). He explained that it is a slow process and made me realize that I have had issues with my ankle since I was 15 years old, now 25, and taking my recovery slowly is important. They did a few ROM things with me and while I could feel it in my tendon, it wasn’t painful. I can handle 2 more weeks in the hard cast. I’m only just starting my 3rd week after surgery so I can’t complain. I will not be going past 90 degrees either. I’m just happy there wasn’t pain today. Thanks for all of your advice guys, I do appreciate it!

  10. mikejp88 on May 7, 2013 10:43 PM

    good to hear it was strong and mostly healthy.

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    I am a 25 year old woman, recovering from Achilles tendon surgery.