2 days short of 11 weeks and I decided to try it out of the VacoCast. My gait is not good, but the tendon feels fine and I am riding my stationary bike and walked a couple blocks, very slowly, today. No pain or swelling. I feel the occasional tweak, but nothing notable. Since I am going it on my own, no one to ask what they think, but I think it is going fine. 
I’m now at 0 on my Vocacast after 9 weeks with no surgery. The problem is when I put the low heel on I seem to be leaning back a bit on that foot when I step and with the heel lift attcahment I seem to be leaning forward a bit. Anyone else run into this issue and what did you do about it?
Also, anyone go past 0 during their rehab? I don’t have a Dr. anymore, so just wondering if that might be a good idea when I am able.
I’ve dropped down 2 more notches on my VacoCast, down to 5 degrees now. No strain on the tendon whatsoever so far. Fingers crossed it will continue this way. No Dr. at this point and not looking for one.
I officially terminated my Dr. the other day. Just a formality. Not looking for a new one at the moment. We’ll see.
Something interesting happenend today, tho. I got a call from the hospital. I didn’t catch his title, but someone from administration. Just wanted to follow up with me and find out why I was terminating. I gave him the short version of the story and he seemed to understand fully. In fact, even tho he is in administration (I think) he had put my initial cast on 6 weeks ago and remembered we had a disagreement over my treatment. He seemed genuinely happy that I was getting along so well. So that was interesting.
As far as my ankle goes, it is still better every day. I dropped it down one notch yesterday with no issues at all. I do think it is probably due more to my belief it was set at an angle it shouldn’t have (the one my Dr. recommended) rather than my great recuperative power. I still hve 3 more levels in my Vacocast before I am at 90 tho.
My name is Dan and I found this blog some time after suffered a full rupture 23 May. I thought it would be a good idea to chronicle my recovery just to add to the posts here for future reference for others. I have read some, but hardly all of the other cases and mine may or may not be different from most. But here it is.
My rupture was caused by a simple accident. I slipped jumping onto log down by the creek and my toe landed on the top of the log, my heel went down and it was ruptured in an instant. I did the usual things after hurting my ankle. Ice, compression, elevation. It kept the swelling down and it didn’t hurt or bruise. But I could tell after a day this wasn’t just an ankle sprain, so I went to the ER. They confirmed the rupture I had self-diagnosed with the Thompson test, etc. They put me in a splint and made an appt. with an ortho, altho not for 7 days. I am not a frequent visitor to hospitals and don’t hve a personal physician, so I went with what they arranged for me.
I should mention at this point I do not have insurance. I know I will be getting a discount equivalant to about half the bill, but more on that later.
So I walked around on crutches (some) for the week until I saw the ortho Dr. In the menatime I found plenty of info regarding treatment and surgical vs. non-surgical. As alot of people here know recent studies show very little difference between the two. So when I went into the Dr. he looked at it for about 1 minute, said I had a total rupture and wanted to know when I wanted surgery. I said that surgery wasn’t as common these days, which he took exception to and said he hadn’t treated anyone non-surgically in 15 yerars. I asked what the cost of that vs. non-surgical tretment was. He had absolutely no idea but said he’d get a nurse to try and figure that out for me. She said $11k - $12k for surgery and $6k - 7k for non-surgical. (Iinterestingly, my Dr. had no idea what he charges, but was able to tell me what his knee surgery cost).
After hearing those figures we discussed it a bit and I said I wanted to go with no surgery. He was not thrilled. He said I would have to have a hard cast past my knee for at least 4 weeks. I begged off that and at this point he said maybe I’d be happier with another Dr. In the meantime he had an intern look up some info online and did agree to let me have a lower leg only cast. So that is what I left there with.
That 4 weeks went by very slowly. I am self-employed and work at home, so that part of my life was more or less the same. I live alone, so things have to be done and I have to do them. I walked around as best I could with crutches and without when I had to. I had no idea what was going on in there, but it felt ok. I have not taken one thing for the pain since this happened, including the day it happened. It doesn’t hurt, it just doesn’t work.
During those 4 weeks I did plenty of research on recovery and the best way to go about it. I emailed my Dr. a couple times to see what his take was on an aggressive approach after those 4 wekks were up. I never heard back. I found out about the Vacocast on here and thought that looked like just what I needed. I wrote asking his opinion of that. No response. So I ordered one anyway. I took it to my appt. 28 June.
They took the cast off and it looked OK, but incredibly weak from non-use and no movement. He looked at it for about 30 seconds and said I should have a hard cast put on at 20 degrees for 2 weeks and then down 5 degrees every 2 weeks, making 8 more weeks in a hard cast. I told him I had brought a cast with me and it was totally adjustable and sounded perfect instead of the hard cast. He did not think that was a good idea and did not look at the Vacocast. He again said I might be happier with another Dr. and said he couldn’t make sure I was doing it his way if I didn’t have a hard cast on. I said he couldn’t do that anyway. I asked if my 2 week visits were just going to be the cast coming off, him saying its fine, moving it 5 degrees and sending me on my way (costing me $$ each time). He said it was very likely to happen that way and I said I was not going go guarantee I was going to do that. He said that was up to me and he left.
So… I won’t be seeing him anymore. He was just too busy and uninterested in me as a person. The ‘I don’t have time for this, just do as I say’ feeling was palpable each time I saw him. Sorry, but I am not a ‘I’m putting myself in your hands, Doc’ kinda guy. In the end I am responsible for my treatment. I am not sure what path I will take as far as formal medicine goes, but as of now I am on my own.
In the week since I put the Vacocast on it has been working out great. I can walk on it with the heel lift and my crutches are feeling lonely right now. Too bad. I only take it off each day to bathe, but the progress is evident each time I do. It feels noticeably stronger every day, which id good because I have a long way to go. Just because I’m not taking my Drs. advice does not mean I am not going to take care of it. It will be a very long recovery, but having it in a hard cast for 12 weeks (minimum) just did not seem like the way to go after all the research I have done about recovery.
That is my story so far.
Dan
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First walking in two shoes is almost always slow and hesitant. Many of us started “with our bad foot forward” and stayed that way for a day or three. A half-decent gait (with a “dip” at the end) doesn’t usually take very long, and a REALLY decent gait usually takes much longer.
Good luck!
Didn’t use a VacoCast myself, but I did use a different hinged boot, so I can take a crack at the second Q. For my second ATR rehab (the non-op one), I thought going past 0=neutral with the hinged boot might be a logical transition to 2 shoes, so I tried it. Something like 10 degrees past 0 dorsi, and essentially unlimited plantar. (I’d been happily hoofing about with 0 dorsi and essentially unlimited plantar. To me it felt scary and uncomfortable, so I stopped.
Since 8 weeks is “wean off boot” time in the UWO protocol, it sounds reasonable for you to try going past 0 with your Vaco if you like — cautiously at first, of course. If it feels good, don’t stop, I’d say. It’s still a lot more protection than a shoe.
My only thought for the other Q is that you might try a slanted (wedge-shaped) footbed, or a heel wedge, that might compensate for the backwards lean of the low heel.
(BTW, the link is near the top of the Main Page.)
Sounds great! Could you pls install the ATR Timeline Widget, so you don’t have to remind us about how long it’s been, where you are, etc.?
Hi! That is a sad reflection of members of the medical profession. If it was in UK you should make a formal complaint to prevent others having same experience.
I managed my rerupture with Vacocast boot seeing consultant to confirm diagnosis and once three weeks later to confirm that there was not a gap that needed repair. After that I was see by a nurse practitioner, it was a waste of time, and then they forgot to send me another appointment. I have not bothered going back.
The most important person is a physio to guide your rehabilitation and advise you how hard to push yourself. Access to gym might be useful but ideally with some physio input.
I imagine if you are self managing you should be a little slower and more cautious than the more aggressive rehab protocols just to be safe.
Thanx for the post Norm. I’ve looked up alot of that stuff but certainly not all of it. My story started out alot like Johannas. We’ll see where it ends, but I am not actively seeking a new Dr. at this point.
Dan, I think you’re doing a great job — unfortunate that so much of the job is fighting the professionals who should be working FOR you. You’re not the first person here fighting that fight — not surprisingly, since this site is such a great source of info, support, and patient empowerment. My fave model is probably johann aka firstdayofsummer — see achillesblog.com/johann, and especially her first 4 or 5 blog posts. GerryR has also made a remarkable progression from compliant patient to aggressive self-advocate.
Others have physically cut off their casts and done other such hairy things that their Docs didn’t recommend. Gunner and Doug53 were both “bad” and did fine. Unfortunately, there are some serious vulnerabilities and some rare complications — and lots of normal worry — all of which can benefit from good professional help, both from Docs and from PTs.
You’ve probably already seen the UWO study (full text posted here, linked on the studies page), and the protocol they used — which I posted one version of at bit.ly/UWOProtocol . It’s one good road-map toward a statistically excellent resolution, either with or wit
[...]Thanx for the comment. I’m not concerned about having a tough time of it here. Things happen like that sometimes and it is part of the deal living here in the good ‘ol U S of A. Not necessarily the best part, but you have to deal with what is in front of you, regardless of where you are.
Hi Dan
Blimey you sound as though you’ve had a really crappy time fella..! You’ve done really well being on your own as well as having to cope with it all.
Things are so different over here in the UK. Although I didn’t get to (and you don’t over here) choose my surgeon etc the care and treatment I’ve had has been first class really and they can’t do enough for you.
Finance wise, the NHS over here is always criticised (sometimes by me ) but the issue that I don’t have to worry over or consider any costs is a massive plus. We do all obviously pay into it with National Insurance etc but the hassle free ” free at point of service” is second to none.
So hiw hard or scary was it to start weight bearing ? That’s my main concern. Do you have a date you’ve set to be back in shoes now ?
Well done with all you’ve achieved so far and keep going. Let us know how you’re getting on
Dave
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