Day 14 Post OP- Doctors Pleased - Cast Off- Walking boot on
Well i went back to see my consultant today and actually saw my scar for the first time. The surgeon said that the operation went to plan and was a straight forward repair. He examined my scar and said it was healing fine and that i could take a shower now and a bath next week……………???? This completely threw me as I was expecting to be in plaster cast for at least another 4 weeks. He then went onto to tell me that I was going to go straight into a walking boot…………………!!
Well this completely shocked me and all the questions I had planned to ask had now gone out the window. The stitches are dissolving and the remains that are sticking out will go when i have a shower/bath. He explained to me how the boot process worked with the heels and how i was to take one layer out each week. He then booked me another appointment to come back in six weeks for another check up.
I was gobsmacked how my calf had deteriorated in only 3 weeks, it just sagged from my leg and I was really gutted. I had expected it but i think the reality was still a shock. I got off the bed and was amazed how limp my leg felt now as it swayed while i took the short journey to the cast room. I Think It was just the feeling of having a weight Free leg with no cast but it did feel weird.
The guy in the cast room then showed me how to fit the boot and heels, he then fitted it for me and let me go. I was still in shock walking out with this walking boot after expecting plaster cast for 4 weeks. I now feel a little disappointed because i did not get to ask many questions about time, exercise, can and can’t do etc. He also told me that once i was comfortable with boot that i could take it off at night to sleep. He told me also to start putting the foot to the floor now and start walking with my crutches putting small amounts of weight on it at at a time. All this was a bit too much for me and I feel now i need to know more as I am not currently confident to do this.
I have more questions, I need more answers, I need more confidence. I feel that I was not prepared for this and can’t imagine how i should start using the boot directly yet. I have read others use the boot after two weeks but never thought I would.
I will have lots of questions for you lot now………………!!
Other pictures available here.
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Daz,
That is a surprise, but the boot looks good, so too does the scar, it looks really neat and not much bruising either. You must be a good healer!!
Make sure you are much more confident before you try to take a bath, I can tell you from experience it is very difficult. I climbed into bath, then ran the water (I still had leg in plaster when I had first bath) rested my leg on a plank over the bath, it was bliss!! To get out, I let the water out put a towel in the bath and went on my hands and knees (trying not to get plaster wet) then pulled myself on to edge of bath, swung my leg over the bath onto a stool etc etc. By the time I was out I was ready for another bath. Anyway, take it easy..
Annie
Hi Dazf,
Good that you got the boot. After 1 week cast post-op, I then had one week cast free, then at Day 15, my foot was bent into 90 degrees (quite painful) then put in a fiber-glass cast again, At day 16, I can walk in this cast without crutches, also slow and also a little funny.
I was quite worried when I was told that I can walk in the cast with my full body weight at Day 15, but I did it on Day 16. I slowly increase my “walking” everyday. Now I am at 4weeks and 2 days post-op, I basically can walk quite a lot (of course with the protection of the cast, I then felt safe about the idea of “walking”), but it still hurts (sting) when I walked too much in a day, but most of the time it was fine. I even bike to work since last TH. It was no problem!
I think getting a boot early is nice, it is slowly getting to 90 degrees not like me, I was bent into 90 degrees by force. I read some papers talk about the benefit of early motion for recovery. So with the boot, you have the opportunity to start early. It was nice that you can take it off at night. So, good luck and wish you a speedy progress on the recovery.
In the picture, you are healing really well, that is really nice.
Ey up Daz,
Well I’m not surprised you feel a bit un-settled - it must have been a bit of a shocker. However as you know I’m at the opposite end of the scale to you and there’s loads of evidence to say that early motion and weight bearing pays dividends. There are also people on the blog who have re- ruptured because of trying too much too soon (6 weeks post op is popular). I reckon the temptation for you to go for it is a v dangerous thing and you’ll have to discipline yourself to be careful. Good luck with it, it’ll be interesting to see how you progress - Richard
your boot is so nice and new!!!!! I know this was an important “step” ha! Good short straight scar. You have made a major milestone!
Hey! What a little incision you have! Looks great! You probably already know this, but when you walk in the boot let you heel lead…so, you are rolling heel, toe.As prior friends said, take it easy and listen to your body. Soreness is ok, a lot of pain means you are probably doing too much. Enjoy being able to touch your leg and the freedom of being cast-free! Congrats!
Great pictures! The scar doesn’t look too bad. I dread seeing mine. Congrats with moving into the boot.
dazf - I’ve created a section for you on the main site: http://achillesblog.com/atrs-in-uk/
Please let me know if you’d like to add anything else there. It’s basically a pointer to your page: http://achillesblog.com/dazfones/uk-atr/
I think it’s a great idea!
Dear dazf, Delighted for you ,looks good.The results from early walking boot and mobilisation are thought to be better really for obvious reasons, morale,mobility ,pain and muscular conditioning.I have a research paper to post re this from a medical literature search.The principles are the gradual lengthening of the tendon as it gains strenghth with reducing wedges.After being immobile adhesions or general stickiness around the ankle joint is inevitable as is pain. Calf maasage and gentle wiggling toes and not over doing the walking to begin with would help.! Best of luck, Mark
I was also given the boot earlier than expected (3 weeks). It was a very pleasant surprise to find out I’d be cast free. (My doc had just ruptured his Achilles & was wheeling around on a knee scooter. He’d said he’d been doing lots of reading on early weight bearing and rehab.) I’m sure you are enjoying your freedom from the cast. Your scar looks like mine though I still have steristrips across the scar. I was told they’d fall off on their own and not to soak too soon as that could open up the wound yet. So, I’m enjoying my showers, but not too long. Glad I’m no longer struggling in & out of the tub. I don’t have wedges in my boot though. Looks just like yours. (I put pix up on my blog) Keep up on the ice & elevation!
Thanks for all your replies, I will be back with loadof questions now.
@dr mark,
I’d love to see that research paper.
As someone who is in the medical profession I would appreciate it if you would have a look at my new post today and give advice.
Darren
I have exactly the same situation 14 day OP. I was given walking boot after 14 days. Now I am trying to put my weight on the boot but still feel some pain. I am not sure if have to overcome pain and keep “walking” anyway
Boris,
I got the boot at 10 days post-op (14.5 now) and was scared as hell…I thought I had read everything on this site but I hadn’t been to dazfones site yet. Glad to read about someone who did (is doing) early weight bearing like me. It took me a few days, but I am now shuffling around without crutches (boot on), so I guess that is FWB? Just take it slow - start by putting partial weight with crutches and then more and more. My issue now is the itchy rash I have developed all up the affected leg. It sucks.
It is astoundingly you are shufting around without crutches after 14 days. By the way what FWB means? I am confused
FWB = Full Weight Bearing, as opposed to PWB or NWB (Partial and Non). I don’t know if the shuffling is good or not. I was shuffling like this in the week between rupture and surgery too. Frustrating intervals in seeing the doctor. I saw him at 10 days after surgery when he took off the splint, removed stitches and put me in the boot. Another 3 weeks before I see him again.
Thanks. I am going to see doctor again in one month too. It seems it is ok, becouse nothing is going to happen before. I was curious if you have phisical therapy procedures between seen doctors. It seems it is extermely imoprtant.
Nope, no physical therapy…that is the frustrating part. I have no idea if what I am doing represents real progress or not. I have to get rid of this rash first before I can even think about moving forward.
I started getting PT at around 2 wks. Not much exercise or manipulation that early for me, mostly gizmos — ultrasound, lasers, and Interference Current, the latter with an ice cuff around my leg. Hard to know if it helped the ankle, but (a) it felt good to be doing something and (b) it felt good to get the foot out of the boot. My physio also gave me a bunch of specific exercises to do. At first, I did them mostly IN the boot, but the later ones (after 4 then 6 wks) were to be done barefoot.
I’d say to avoid the pain when starting to shift your weight onto your booted foot. I stopped just short of the “pins and needles” or “electrical shocks”, and I progressed pretty quickly from NWB to PWB (either Partial or Protected) to FWB.
Now (7 wks) I’m clomping around at high speed and even skipping some when I’m in a rush.
Getting rid of the heel lifts was interesting for me, as I blogged on mine. Moving from 3cm heel lift to 0 was too much for me, and even 1cm seemed too flat, so 1 went from 3 to 2cm for a couple of days, then to 1cm. When I moved from 1cm to 0cm I was expecting it to be “a stretch”, but it was actually MORE comfortable than before.
As I removed the heel lifts, though, my heel kept “telling” me that it was a lot closer to the hard floor or pavement, and the shock of impact got greater. I responded by adding a slab of foam (”ensolite” from a cut-up cheap camping pad) under my whole foot.
I also cobbled together an ugly elevator shoe for my “good” foot, to make it as high as my booted “bad” foot, so I can walk straight. It’s made out of a cheap nylon-and-velcro “cast shoe” I had hanging around from my first ATR, 8 years ago. I just use it indoors, and I’ve added some footbeds to a semi-boot that I wear out, so it’s almost as tall as the boot, too.
BTW, are you “right-footed”? Most right-handers are, and most of them/us tear the dominant-foot-side AT first, according to what I’ve read.
The standard test of “footedness” for us Canadians is to run and skid on an icy sidewalk. The foot you put in front is your “lead” foot. I’m in the majority, right hand and left foot — but like you, I tore my right AT first (playing Volleyball). 8 years later (7 weeks ago), playing even MORE aggressive volleyball, I tore the left one.
It’s possible that we folks who tear the “wrong” AT first are at even higher risk of tearing the other one later than people who do it in the more popular order. . .
Normofhtenorth: interesting re. the dominant foot and all. I guess I am left dominant (right handed but I always rode a skateboard right foot first - the vast minority do it that way - as a kid it was referred to as “goofy” footed ). We have no ice here in Georgia, but I would slide right foot forward for sure. I ruptured my left Achilles.
Curious re. the re-rupture - after rupture #1, did you stretch & warmup before playing sports? Did you re-rupture anyway? I’m trying to figure out how to avoid rupture #2!
The quote below seems to be borne out by the fact that there are far fewer “righties” on here than “lefties”- I always notice the righties like me, because we’re the ones moaning about not being able to drive- and we definitely seem to be the minority.
“Most Achilles tendon tears occur in the left leg in the substance of the tendoachilles, approximately 2-6 cm – the “watershed zone” – above the calcaneal insertion of the tendon. That the left Achilles tendon is torn more frequently may be related to handedness; right-handed individuals “push off” more frequently with the left foot.”
from Achilles Tendon Rupture
Author: Brian A Jacobs, MD, FACSM, Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School
Coauthor(s): David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic; Evan Schwartz, MD, Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John’s Queens Hospital, Department of Surgery, Albert Einstein School of Medicine
I was curious if someone has expirence to effectivly reduce swelling after 14 days OP and feeting leg in the boot. It seems like this is bigest obstacle early weight bearing . If you place the ice what is the right way to do it?
My boot “Maxtra” has some angle adjustment which allows to ajust my foot postion. Trying to figure out how often do I need make this angle changes?
Tom, sorry I missed your question. I’ve always warmed up before volleyball, but I don’t always stretch — and the scientific studies on stretching show as many problems caused as benefits, BTW!
My rupture #2 wasn’t a re-rupture, but a “contralateral” rupture — i.e., I tore the other one. (I keep thinking it’s “transaxle”, but that’s a car part!)
Re-ruptures are very rare after you make it through the first dozen or so weeks. Transaxle ruptures are pretty rare, too, but WAY more probable than first ruptures — and we’ve all already “won the lottery” on THAT one! There’s a study of the probabilities at http://achillesblog.com/files/2008/05/previous_achilles_tendon_rupture.pdf , linked from http://achillesblog.com/atr-rehab-protocols/ . It found I was at almost 200 TIMES the “normal” risk of tearing my other AT, because I’d already torn the first one — and (a) that study included people who quit the high-risk sport after their first AT and (b) that study only followed up for 4.5 years, and my second ATR came EIGHT years after my first!
The NYTimes had an excellent article (with a video!) on stretching around a year or so ago, and Australian radio (ABC) did a good show on it, too, a couple of years ago, on their excellent “The Health File” show.
I think Cdn Broadcasting Corp.’s “Quirks and Quarks” also did a good item, called something like “everything you thought you knew about exercise is wrong!”
Obviously, anybody who tears an AT doing sports is in a high-risk group, probably from a combo of (1) doing that sport, and probably doing it aggressively, (2) some baseline (probably inherited) condition that predisposes us to ATRs.
One plausible theory I’ve heard about (2) is that there’s very little blood circulation at the AT, and the bottom is nourished by blood flow from below, and the rest by blood flow from above. In-between those two “zones”, there can be a zone of stagnation, or insufficient blood flow, creating a “tear on the dotted line” area — and some people have more of that problem than others.
Some people tear an AT and give up squash or volleyball or soccer or whatever, and they’re probably not very likely to tear the other one. But those of us who go back to aggressive stop-and-start sports, as I do, are clearly at risk of “doing” the other one (as I did).
Personally, I would do it again in a heartbeat, for all the fun and good exercise I’ve had playing 7 years of “killer” volleyball. In fact, I switched all my indoor court volleyball from the normal 6-on-6 to the much more energetic and aggressive 4-on-4 in the interim — despite the fact that I had “matured” from 56y.o. to 64!
And this second ATR has been healing spectacularly so far, WITHOUT SURGERY, so I can’t complain on that front, either. I’m not finished yet, of course, so check my blog to see if I change my mind. . .
But if things continue to go well, I expect (and hope) to return to the volleyball court.
BTW, that study on contralateral ruptures found that a couple of percent of ATR patients tore the other one within ~4.5 years. So it’s still quite unlikely, but WAY more likely than the risk of an ATR for a random “normal person”. And if they followed up for a decade or two (thereby catching “late bloomers” like me!) they’d find slightly higher risks. And if they only studied those of us who DO return to our high-risk sports, they’d find even higher risks.
On one of my first trips to the Sports Med Clinic this time, I met a guy in the waiting room who used to work in a Sports Med Clinic. He made it sound like MOST of their ATR patients came back a few years later after tearing the other one! I don’t think that’s right, but a Sports Med Clinic would tend to see the keeners, and the keeners are clearly more likely to tear either AT, on either side.
But heck, I’ve seen way too many of my volleyball teammates and opponents sidelined with injuries. If I dwelt on the risks when I played, I’d stop playing, ’cause it wouldn’t be any fun! But the risks are there.
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I am 4 weeks in a cast..another week and I go into a none weight bearing boot..not sure how long this will be.does anybody know if younhavevto sleep in it. Thanks Helen
Helen - you may not have to sleep in it but you should consult your doctor. Not sure why you would go into a NWB boot at 5 weeks when you could be weight bearing by then so maybe you should discuss the reason with your doctor and just confirm the instrucions. I doubt there is any other injury that has so varied treatment ideas. It all gets a bit confusing especially when we read these blogs and see how others rehab. What is the best way? I have no idea. I only know what worked for me.
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