ATR + (almost) 10 weeks

Tomorrow will be 10 weeks since my ATR. I went through conservative treatment (no surgery). My right leg was in a cast for six weeks, first four in a “toes-down” position, last two in a more neutral (but not exactly 90-degrees) position. My doctor by-passed the boot and went from NWB in the cast to FWB once the cast was removed. Below is a summary of my week by week experience since the cast was removed:

ATR+Week 6: Cast removed in the morning. I started experimenting with walking without crutches and managed to get rid of the crutches the same day. My walk was anything but graceful but I did not need those crutches anymore. A big sigh of relief and a sense of freedom.

Started PT the next day. PTist put me on stationary bike and theraband (blue). In addition, I found massaging my AT area helpful. Stationary bike is amazingly helpful in relaxing the ankle and gaining flexibility.

Week 7 & 8: Continue with stationary bike & theraband. I tried toe-lifts (both feet, flat surface) after a 15-min bike exercise. I found it easy to do so added it to my exercise routine. My PT thought is was ok to do so. My routine was:

  • Stationary bike - every second day, 15-20 mins at a low resistance
  • Runners’ stretch (face against a wall, stretch one leg at a time) - everyday
  • Theraband (blue) - 2×10 repeats everyday
  • Toe-lifts, flat surface - 2×10 repeats everyday
  • Ice treatment after exercise

I was having swelling at my ankle after work. I have an office job. Normally, I walk around quite a bit but have been spending more time at my desk since injury. PTist recommended compression socks, which helped with the swelling. I started wearing them regularly.

Week 9: PTist thinks progress is very good. I gained ~80% of my flexibility (which was not much to begin with) and, say, 50% of calf strength (% are my guesses, not the PTist’s). I asked whether I could ride my mountain bike (on a flat trail) and she said “no way!” OK, you gotta ask. She added dropped toe raises to my routine. I don’t know if this is the right name but here is how it is done: One stands on a stair on the balls of the feet, with heels sticking out. Holding to a support (eg., handrails), slowly lower the heels as far as one can comfortably go. This stretches the calf muscles & the AT. Then, lift the body on the toes as much as possible. Repeat.

I added this exercise routine, repeating everyday. After a couple of days, while walking down the stairs, I felt pain in my now-healing AT. The pain did not linger but repeated every time I stretched my AT. I stopped the dropped toe-raises and reduced other exercises until it was time for my PT session. I also had a bit more swelling during these few days, which I handled with ice compressions.

At the PT session, PTist agreed with my exercise reduction and suggested an in-between exercise: put the good foot up the stair, keep the bad one one step down. Then, do toe raises on the bad foot. This way, some of the weight is on the good one but the bad one carries more than half the weight.

Week 10: Exercises going well. I am feeling ready to go back to dropped toe raises but will wait until I see my PTist. I am walking with an obvious limp but it is getting better day by day. At slow speeds, it is almost unnoticeable. I even danced (or so I think) at a friend’s wedding this past weekend. I cannot wait until I can get on my bike and go for a ride outside. Also, I am really hoping that I can squeeze in a SCUBA diving trip before the summer is over. I will see my doctor this Friday and will ask him a few questions.

6 wk + 2 days post injury

My cast came off yesterday (6 wk+1 day post injury, conservative treatment) and my doc sent me home. He did not give me a boot and told me to follow PT and do things that I am comfortable with. It was a great relief to get the cast off my leg. Felt light and airy - such a nice feeling.

So, yesterday, I experimented with a few things:

  1. Remove weight from crutches but keep them for balance. This worked out well and after a few steps I was able to put almost no load on crutches. 
  2. Eliminate one crutch and keep the one on the bad side. Same as above, it took only a few steps to feel ok with this.
  3. Feeling motivated, I got rid of both crutches and walked around with a cane. This was easy too. Soooo, I took the next step…
  4. No cane, just my two feet. I now can walk, after about 24 hours post cast removal.

During these exercises, first I felt some soreness on the bottom of my feet and around the heel (bad side) but nothing unbearable. The soreness is mostly gone after about 5-6 hrs. Also, the bad side ankle is very stiff. I can move my foot downward maybe around 10-15 degrees but hardly up. I was a bit worried about waking up even more stiff after a full night of inactivity but that was not the case this morning.

The “walk” is very limpy, mainly due to ankle stiffness. I also have a sore spot on the top of my foot. PT says it is “collateral” damage, healthy tissue stiffening up due to immobility. She said it is ok to push that area harder than the AT. She also told me that at the 6-wk mark, the AT is about 80% healed and I should be careful about my activities for another 6 weeks or so.

I had my first PT session this morning, which was mainly an assessment session. Main issues are, as expected, flexibility and calf muscle loss. She gave me a few exercises:

  • Toe push against elastic band
  • Heel raises while sitting down (no load)
  • Achilles stretch (against wall, leg stretched back, aka runner’s stretch)
  • Stationary bicycle - she said this was a very helpful exercise. Keep resistance low and maintain around 80-90 RPM.

I asked her about walking exercises in a pool. She said it would be helpful but she was not too enthused about it. I think I have enough of a homework with the above four exercises, pool can wait a bit.

At this point, I am feeling very optimistic but the fear of rerupture is there too. It will be a few more days, I think, to gradually increase the exercise level to find out the optimum point. For now, I am happy to have come to this point.

FWB or 2-shoes?

Today is my 6 weeks+first day since injury. Went to my doctor this morning for removal of the cast. Having read blog postings of those ahead of me, I was expecting to get a air-cast boot. He checked my leg out, told me that he was very happy with the progress and told me to go home and follow through with my PT. That’s it, no boots, nothing.

He told me to start putting weight on my leg, work on flexibility, and go on with life. He also told me to be patient and pay attention to PT.

I am happy to be off the cast. I am still using the crutches but I can stand on both feet easily. I can walk with little support from crutches but don’t feel comfortable completely ditching them yet. Stairs already feel much more easier with the stability of both feet (holding onto the rails & crutches). Naturally, I am far far from walking normally yet.

So, am I FWB or is it 2-shoes? Don’t know, don’t care. Happy to be on my feet again and looking to work on my flexibility & calf strength. Speaking of my calf, boy, the atrophy is scary. My right (bad) leg looks half the size of the left one. Not sure if it will ever get back to what it used to be but I sure will try.

Anyway, I am happy to fast forward to standing on both feet without having things attached to my leg. It is a good feeling.

Wish all a speedy recovery. I am working on my own.

Top ten reasons to look on the bright side of an ATR recovery period

10.You get a preview of old age, when you will need a cane to walk.

9. You never need to think about an ice-breaker in parties.

8. Helps you slow down in life and savor the moment.

7. You have a good excuse for not doing chores.

6. You get a break at work/home/wherever.

5. Suddenly, everybody wants to talk with you.

4. Doors are opened for you, coffee/tea comes to you, your things are carried for you.

3. You notice things you did not before (because you are slower - see #8).

2.People are so nice to you.

And, the number 1 reason:

1. You get to spend more time with friends & family who are concerned about you.

Summary up to Week 5 post injury - still in cast

I just found out about this site. So, here is my story, which covers from the day of injury to week-5.

I injured my right AT while playing soccer. Up until the injury, I have had a series of AT issues, which I realized after the fact that I could have taken better care of. I have had an active lifestyle up until the injury. While I was younger (read high school & university years), I regularly played soccer (nothing competitive but 2-4 times per week). Later on, I picked up squash and mountain biking as my higher-impact activities. My soccer games became much less in frequency, dropping to about a few times a year in the past five years. I also have had tight calf muscles and poor flexibility. I pay attention to properly warming up before playing sports but stretching has never been an exciting thing for me. Well, now, I am paying for it.

Earlier this summer, I was happy to join a local league and start playing soccer again. The first two games were ok but I felt tightness in my calf at the third game of the season. I left the field, applied ice, saw my doctor, and followed her advice (take anti-inflammatory medication & don’t play for two weeks). Two weeks later, it was the fourth game of the season. Arrived at the field a bit early to spend a bit more time warming up & stretching. Game started when I thought I was good to go. Just a few minutes into the game, while chasing a ball, I felt like someone took a good kick at my right heel. I also heard a “klunk.” Next thing I know, I was lying on the ground and was fully aware of what happened to me. Still optimistic, I asked my teammates if anyone kicked me. They gave me a puzzled look and told me “no.”

Long story short, I was carried out of the field. Paramedics arrived and confirmed what I thought was the case. I went to ER that evening, got a temporary splint and an appointment to see a doctor in the morning. My doctor recommended conservative treatment (no operation) as “there were still a few fibers” holding myAT. First cast was put with my foot in a “toes down” position. That cast stayed for four weeks, until last week.

Last week, my doctor removed the cast and told me that it was all healing well. Although I was mentally prepared to see a miserable leg (atrophied and limp), the sight was still depressing. Between casts, I cleaned up as much dead skin as possible while trying not to move my foot.

A new cast is put with my foot in a more natural angle (but still not 90-deg). Now, I am on day 33 of my total 42 days (6 weeks). I booked my PT on the day after my cast is scheduled to come off. I hear that PT is the painful part of the healing process (I have had almost no pain so far) and I am so motivated to get it through.

A few resolutions came out of this experience:

  1. Learn to stretch and do it!
  2. Get into flexibility-increasing activities - yoga anyone?
  3. Bite the bullet, take the pain, go through PT as quickly as possible (but not too quickly).

Now, a few questions:

  1. Please let me know your cronology for recovery. I know this wildly varies from person to person but I am curious to know how long it takes to get rid of the crutches/canes, how long till first sports activity, etc.
  2. All suggestions are welcome regarding improving the recovery process

I wish everyone a speedy and full recovery.