Funny thing about perspective.

July 1st, 2011

When I asked my surgeon about his protocol at my 10-day post-op appointment, he said “Every doctor will tell you something different. Another surgeon in this same hospital would come in here and plan a totally different treatment for you. But mine is quite aggressive, and I think that’s what you want. It has worked well for my patients, I get good results.” And I guess when I read stories here of people who are casted for weeks or months with no weight bearing, he is aggressive. But yesterday I had my first appointment/consultation with a new PT (I wasn’t super happy with my first), and she looked at his instructions and said “Dr. X is pretty conservative. He doesn’t take his patients out of the boot until 12 weeks post-op.”


Anyway, I am thrilled with this new PT, except that she’s quite a bit further away, harder to get an appointment with and is more expensive (which means my insurance won’t cover as many appointments). My GP recommended her, but I couldn’t get a quick appt. so I had booked in with a PT across the street from my office. The first one was lovely, but she was following Dr. X’s instructions to the letter, only allowed to flex with theraband, no weight bearing w/o the boot. This new PT immediately got a sense of my frustrations. She said my tendon looks good, though the scar is a bit “sticky” with adhesions, so I am to do scar massage often to try and loosen it from the tissue underneath. My range of motion is also good. She added:
- seated heel lifts, to get my foot and the tendon used to the motion of rolling up through the foot from the floor.
- Crunching a towel up under my toes.
- Standing up without the boot (!!!) and rocking, very gently forward and back, side to side, again, to get my foot and tendon used to movement again.
- Standing and holding onto a counter and lifting my heel, rolling my foot up.
She also advised me to add an orthopedic footbed into my boot. She said it’s just so flat in there, not good for the rest of my foot, and for many people they come out of the boot and immediately get plantar fasciitis. Did that — now I have to figure out how to compensate for the extra height in my other shoe. Again.

She also said — and I share this with anyone else who was feeling frustrated with their first few PT appointments — that there just isn’t much we can do until the boot comes off. But once it does, boy, we’re going to town. So she sent me home with all these new exercises and advice. If I get to ditch the boot after my next doctor appointment July 11, I will see her the same week. If not, I am to cancel that appointment, and schedule one for after the 12-week mark. She’s trying to save up my insurance money for when it will be most useful. I’m very happy I did a little shopping around.

One thing I’m really enjoying about this injury: every nurse, doctor, surgeon, PT I talk to says, at some point, “ … because you’re so young …” Ha! I turned 40 last year, and felt as old as the hills. It cracks me up that when it comes to this injury I seem to be some kind of spring chicken.

I know many of you are from the US (and the UK and New Zealand), but I still hope you have a happy Canada Day today!

8 Responses to “Funny thing about perspective.”

  1. polly on July 1, 2011 12:24 pm

    Happy Canada Day! Do you blow things up on Canada Day like we do in the US on July 4th?
    It sounds like you are making wise decisions with your new PT. The shopping around/extra drive to get there will probably pay off as it seems the new one is on the same page as you. I have no idea how long I will be in a boot, but my surgeon also said said something about no agressive PT until the boot comes off. The @ honme exercises she gave you, you do them with or without the boot on?

  2. Stuart on July 1, 2011 6:30 pm

    How great it is that you have found a physio you can trust and one that will work hard for you and even try to save you money. I was also interested in the comments about plantar fasciitis. Having suffered from it before when I was running ultra marathons, I was aware that it could be a problem again when I started to walk in two shoes again. The lack of dorsiflexion at the ankle puts more stress on the plantar fascia when you walk and less stability in the ankle can cause you to roll in which also puts more stress on that tendon.

    Fortunately the physio I had at the time made some soft orthotics (specially for runners) and told me to ditch the Nikes. Since then I only ran in the best Asics or Brooks with heel stability. The week before I was due to go into 2 shoes on I took a couple of different shoes to my physio for her to OK. I feel so much more confident and stable walking around in two good shoes and the last thing I need is to have another tendon problem.

    For those not sure how to check the stability and suitability of your shoes. Firstly the heel should be higher than the toe. Next, hold the shoe at the toe and heel then bend it. If it bends in the middle then it is NOT good. It should bend under the ball of your foot. Next twist the shoe. Again the shoe should only twist from under the ball of the foot with the arch and heel relatively stable.

    Funny that my current physio also said not to use Nike and only use the top Asics or Brooks designed for long distance runners.

    Take a tip from Deana and find a good physio.

  3. Dawnn Williams on July 1, 2011 8:03 pm

    Deana, Glad you like your new PT. I hope you get the okay to ditch the boot. It feels great even though caution is the order of the day. Every doctor or nurse or med student always say “54 year old woman” so of course I hate that. I guess I’m at the age where this is expected. Anyway sounds like your making good progress and that your spirits are up.

  4. mtbrider on July 1, 2011 9:01 pm

    Man, I am sooo looking forward to getting PT when the time comes. I am even a bit excited about finding a PT. Am planning on ringing a few up first to see what their experience is with AT’s and also what their usual plan off attack is. YOu mush actually feel like to are making progress now, being able to do some/any form of exercise sounds great. I am jealous but realise my time will come.

    As for the comments on your age, I am getting the same thing and I am 34. I did read on some forum somewhere about an 18 year old male that did his playing football, can only imagine the things being said to him.

    Laters and take it easy.

  5. deana on July 2, 2011 1:40 pm

    Polly, I do my home exercises in bare feet. From the first week I got into the boot I started with very gentle range of motion exercises (circles, point and flex, writing the alphabet) while lying on my bed. And yes, we like to party on Canada Day — parades, fireworks, barbecues — but I don’t think we do it up quite as big as you do south of the border. Happy 4th on on Monday!

    Thanks for the tips about finding the right footwear, Stuart. I’ve been thinking a lot about what shoes to wear and will take your advice to heart. I definitely don’t want to deal with more issues because I made the wrong choice.

    Dawnn, I think my biggest lesson here is not to take my properly functioning body for granted, no matter how old it’s getting! After this I plan to work it out and enjoy my mobility as much as possible, for as long as possible, even more than I did before. I say an active, life-loving 40-year-old (or 54-year-old) has lots more going for her than a couch-surfing 24-year-old!

    And mtbrider, your time will come sooner than you think. I’m surprised by how fast these 8 weeks went by. I have a feeling the hard work is only about to begin for me now.

  6. normofthenorth on July 3, 2011 1:56 am

    Back in 2001 when I tore my first AT, I read that the peak decade for ATRs is 30-something years old. I’m guessing that it’s creeping up as more of us >40s stay active and competitive long enough to tear an AT at a much older age.

    Deana, I recommend, either as a tested-and-very-successful protocol to follow, or as a benchmark to compare your rehab protocol to. PT and exercise start at 2 weeks post-whatever, “wean off boot” is at 8 weeks, etc., etc. That’s six weeks of pretty intensive PT (though starting gently) while still in the boot — though you’re OUT of the boot during your PT appointment, of course!

    I also don’t “get” the association between PT and “2 shoes”. In fact, fairly soon after I got into 2 shoes at 8-ish weeks, my PT handed me over to the exercise/gym/machines lady, because I was then more in need of exercise than PT. (I actdually stopped showing up then, and did many of the same exercises on my own instead.)

    I also found that ditching the boot was a relatively over-rated milestone. (FWB is my fave, though walking limp-free, doing a 1LHR, and returning to “high-risk” sports are also huge.) Footwear and leg fashion aside, when you go from FWB in a boot to walking in 2 shoes, you’re suddenly super-vulnerable to reinjury, and you’re LESS mobile than you were the day before — e.g., your walking pace slows WAY down, and walking in crowded places suddenly became scary. How is that a great breakthrough, compared to the first day you can carry beverages and stuff across a room??

    Good luck with the new PT, and your continued healing and rehab.

  7. deana on July 3, 2011 11:16 am


    I suspect the biggest difference in our experiences with FWB is that your boot was hinged, so you could adjust it as you healed and were able to feel like your calf and tendon were working and getting stronger. If I went through this again, I would spring for the hinged boot.

    You’re right, losing the crutches was a big milestone, but I think it snuck up on me. I suddenly realized I was carrying my crutches more than leaning on them, and after you suggested I try putting my good foot further ahead and rolling through, I figured I was FWB. But it is the boot doing all the work. Locked inside, the calf and tendon do nothing, and my calf has all but withered away. I think in the back of my head I wondered if my AT was really fixed and if it would be strong enough to support me without the boot. Which is why those first few steps in shoes felt like a much bigger milestone to me. You’re right, it’s slower and scarier and I will stick with the boot for going out (and for having a glass of wine, which I did with friends last night), but it does make me happy that everything seems to be functioning and I that can get that calf muscle working again.

  8. normofthenorth on July 6, 2011 12:10 pm

    Sounds great, Deana! The angle adjustment in a fixed boot (by removing heel wedges) is exactly equivalent to the angle adjustment in a hinged boot, in the early stages (when the boot is “locked” at one angle). Your ankle, calf, and AT can’t tell which one you’re using. The only functional difference is late in the boot part of the recovery, when you can unlock a hinged boot, leaving it restricted only in the dorsiflexion direction. Typically, it’s set up so it can’t dorsiflex past neutral, but it can plantarflex like crazy (either a lot or without any limit).

    FWB is FWB, even in the boot. It’s about weight bearing, not about calf or AT strength. When you’re standing on your booted foot, lifting the “good” foot to walk forward, every ounce of your weight is being supported by your booted foot and leg. Sure, much of the job normally done by a healthy AT and calf is being done by the boot — that’s why it’s THERE!! But supporting your weight is important for your leg’s return to health and strength, too.

    Many of us with boots took them off frequently to do (gentle) exercises and to get PT (starting at 2 weeks in, for us UWO followers), and my PT even made me hobble around barefoot from one PT station to the other — LONG before I was even remotely comfortable doing so! For us, starting to toodle around the house in Crocs was a milestone, but I still loved FWB more, when I could carry stuff. (Mind you, carrying crutches or a cane doesn’t really “do it”!!)

    So don’t let me rain on your 2-shoes parade! You should take as much joy as possible from every milestone — you deserve it!

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