4 weeks post-op (and a treatment pattern question)

4-week update

In my last update (at the 2.5 week mark), I wrote about frustration regarding my limitations. My doctor, at 3 days post-surgery, had given me permission to go full-weight bearing while in a gravity-equinus cast. I wasn’t ready at the time, to do that, and even at the 3 week mark I wasn’t doing much more than light weight-bearing while using two crutches.

Thanks to the advice of fellow AchillesBloggers, during the fourth week (the last seven days), I trusted the cast to protect my healing Achilles tendon and have been able to graduate to walking without crutches. My walking is slow and with an obvious limp, but I’m working to smooth that limp out.

Walking in a cast shoe

A question about my recovery/treatment pattern

At my first post-operative consultation, my OS didn’t give much explanation on how my recovery would be managed. I was to be in a gravity-equinus cast for four weeks, ramp up to weight bearing, the cast would come off, and then something else would happen. All along, I’ve been assuming I would move into a below-knee walking boot (like a VACOcast), because everyone else seems to move into one of those. I’ve been looking forward to this because the cast is generally not comfortable.

However, I spoke with my OS over the phone this morning, and he informed me that his plan is to go from the gravity-equinus cast directly to a plantigrade cast, for an unspecified amount of time (I wasn’t able to have a long conversation with him). I get the feeling that it will be another four weeks in this plantigrade cast, followed by who-knows-what.

I’m not keen to go into another cast, for that long, for the following reasons:

  • Going directly from gravity equinus to plantigrade doesn’t give me a chance to get used to the change by doing stepwise angle adjustments, which you would get with wedge removal in a boot.
  • A cast prevents me from being able to start physical therapy, or do any ROM exercises, until it is removed. The median start date for PT is around week 6, and if I feel ready at week 6, I’d prefer to start then.
  • A cast prevents me from being able to wash my leg, or sleep without this added weight on my leg. I’ve read from many AchillesBloggers that it’s common to start removing the walking boot for showering and sleeping around week 6.

Anyway, I said there’d be a question here, so here it is: am I crazy to want to do something different than another cast?

Quick update post-consultation

Thanks for the feedback, oscillot, Kent, and Sneaker!

I ended up bringing an orthopedic boot with me (the VACOcast Pro) to the four-week post-operative consultation. When the doctor came in, I requested that he clarify my treatment plan, and he said that the next step was a plantigrade cast for a further six weeks.

So I asked about using the orthopedic boot, as an alternative, and he was receptive. It was a modest surprise to him, but he warmed up quickly. He did offer a few words of caution — basically, make sure I’m wearing the boot when walking.

The cast came off, we inspected the incision site (healing nicely) and it turns out my calf atrophy hasn’t been too significant (knocking on wood). Or, at the very least, my calf is not twig-like. Then my leg went into the orthopedic boot, immobilized at 30 degrees below neutral, and I went home. Next consultation in two weeks.

My plan for the following few days is to get used to the new boot, and move toward neutral position.

6 Responses to “4 weeks post-op (and a treatment pattern question)”

  1. Your doc has some unique ideas, suggesting you should bear weight at day 3 and stay in casts longer than most. It might not matter in the long run so long as you are immobilized at appropriate angles, but you’d be a lot more comfortable in a boot. I liked having the freedom to adjust my angles +/- 5 degs based on how I was feeling that day, and I do think the nightly washings helped me mentally prepare for 2 shoes.

  2. yes seems different. I was two weeks in a splint then one week in a hard cast and then moved into boot. Just started therapy at about 8 weeks. Best of luck to you.

  3. Its a different approach with each Doc, even in the same countries from what I have seen.

    My Doc does not believe in full immobilization for more than 10 days.
    He had me walking in a tall boot since day 11 post-op, removing wedges each week and start light PT as well.

    I see the results from it already, as my AT is very strong and my surrounding muscles and calf have lost very little gains compared to what I see all around.

    After week 6, he cleared me for 2 shoes at home, but even with this progressive approach - prescribed the boot to be worn at all times outside home for another month…

    So, its a different approach and timetable for every Doc - I wouldn’t draw too much conclusions if yours differs from the majority out there.

  4. At least it looks like you are walking great in your cast. I have been in a hard cast now for almost 6 weeks NWB!! It is ridiculous, can’t see the incision or anything. I’m starting to wonder about my doctors protocol.

  5. My plan is two weeks splint (done), two weeks hard cast (1 week served, but I can at least drive limited trips to the ice rink with left foot), then two weeks in a boot and I can start PT at that time too. When they took the split off and removed some sutures, I saw the incision - definitely something for Halloween. Anyway, four weeks of NWB should not be too bad - the cast is irritating though. Before surgery, it looked like the best plan is to limit your time in a cast.

  6. Hey Liverpool, you are kidding, right? The driving I mean of course. An insurance nightmare!

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