Jun 02 2010
The Delights of the ROM Boot
Now about 10 days out of cast following surgery to repair my re-rupture, i am once again enjoying the relative freedom of the ROM boot. When the medics cut off my cast and fitted my boot, they could not get to neutral so left me with 10 degrees of plantar flexion. However, within 4-5 days i was able to adjust the boot myself to neutral, and on advice from my surgeon he is happy for me to weight bear in neutral. Not sure whether there is a standard boot used in the UK, both times i have had the ROM walker from Townsend:
http://www.townsenddesign.com/Townsend_Design/Walking_Boots.html
I am back with my surgeon on Monday. Ostensibly, this was so that they could adjust me to neutral - slightly superfluous now but will be useful to get a physio referral.
I find i am being very careful second time round. I am wearing the boot to bed, which i didn’t do first time, and i am still using two crutches, although in truth i am taking more and more weight on my leg and less and less on the crutches.
After the initial repair i had conservative / non-surgical treatment, and after the re-rupture i had surgery. I know it’s a really live debate as to which is ‘best’ (i know some believe debate is in the past on this point!) I can say that my foot is a lot less red now, implying much better blood flow, and my achilles feels a lot thicker / more robust to the touch. However, i am well aware this could be wishful thinking / scar tissue / mind over matter! I am looking forward to rehab, but i am doing so with the absolute certainty that this time i must not push too hard!
That boot looks virtually identical to the one I used (whose brand name escapes me now), except that yours has a much bigger-taller “toe box” in the picture you linked.
No comment on the “debate”! But you deserve a break, so I certainly hope that you do much better post-op than you did post-NON-op! (We are all anecdotes, not statistics!)
Congrats on a big step. Let us know what your PT prescribes for starters.
David
I am 2 days in to a near full Achilles rupture and am in a splint/cast, while I await my fracture clinic appt ( which is in 9 days) at Stepping hill hospital ( I live in Stockport)
I am keen to know when the ROM boot is generally worn from in terms of timescale after said rupture, and also if, in your opinion I should push for the surgery rather than the conservative route.
If they won’t provide a rom boot, which I would imagine they won’t, I will purchase one myself.
I think it would make the recovery more manageable.
All comments welcome
Regards
Chris
Hi Chris
You’ve arrived here at a 2010 blog which is ok but you may be missing reading more recent information. At this stage I would suggest you create your version of the blog and timeline by going to achillesblog home page where you will see how to start, as well as lots of guides etc.
I found a boot with ROM capability (Oped’s Vacoped Achilles in my case) to be excellent and, I feel, helped to maintain flexibility and minimise atrophy. I was fitted with mine after 2 weeks in a lightweight cast, with the ROM being increased every 2 weeks until I went 2 shoes at week 9. By the time you go to the clinic, your leg, if cast in the equinous position (around 30ยบ down), should be in the early stage of healing.
I don’t know why, from what I read in your post, you would be pushing for surgery. Non-operative care under comprehensive guidance and physio support is not, as many would have you believe, inferior to surgery. Cecilia’s blog has a chart of 3 modern protocols, 2 from UK and one from Canada, all of which show results as good for non-op as surgical. When you read reports, and see that one or two have re-ruptured, just remember that occasionally it can happen through simply slipping, or another incident. In most cases the boot will keep you safe and sound throughout.
Sometimes non-op may be called ‘conservative’ - in modern terms this does not mean slow. It refers to the lack of invasive, riskier treatment as incurred in any surgery. I meet the specialist once and would only see him again if I had a problem that the highly capable physio team needed advice on. I didn’t have any problems but the doctors were always there.
The report below refers to one of Cecilia’s listed hospital’s (Exeter, which is NHS Foundation) and much more can be found on Suddsy’s web pages, including Exeter’s full rehab protocol:
bjjprocs.boneandjoint.org.uk / content/95-B/SUPP_18/16 .abstract
Exeter (NHS Foundation as is yours) did supply my Vaco boot so don’t assume just yet that yours won’t. These boots are expensive to buy outright but work out ok due to having mostly replaceable parts allowing boots to be recycled and put back into stock.
Good luck, start that blog, keep reporting!
+1 to Billie’s post!
Cecilia’s link to the Wallace study - at ach… blog.com/Cecilia/protocols - is also worth following. Me, I’d share a printout with my OS or consultant, and try to get him/her to palpate and inspect your gap while you’re in equinus, to choose the perfect ankle angle to just bring your torn tendon ends together (to “approximate” them), as Wallace did for his ~950 non-op patients, with wonderful results.
I think this practice should be standard practice globally, not unique to one Doc in Ireland!