eddienomura’s AchillesBlog

PWB at 5 weeks in Das Boot
July 9, 2014, 5:56 pm
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Upgraded to PWB in the boot! Doing my home exercises daily, ROM and strength improving. Going back to work (office job) at the end of the month and as long as I’m FWB in the boot by then all will be well. My second follow up doc appt is on Tue 7/15 fingers crossed. Thanks to everyone that posts, I read them daily and happy healing!

Barring unknown complications, if you’re PWB now, you should be able to transition to FWB within 2 weeks. Know, however, that part of the challenge here will be mental, that you can trust your injured leg to support you. It might feel weird at first, but as long as it’s not painful you may need to push-through some of those uncomfortable/odd feelings of weight-bearing again–I know I did at this stage. Good luck! -David

Comment by davidk 07.09.14 @ 6:39 pm

Thanks DavidK!

Comment by eddienomura 07.09.14 @ 9:04 pm

Great news moving to PWB! I look forward to that myself but am a few weeks off still. Glad to hear you made it at 5 weeks. Keep up the exercises and best to you on the 15th! since you’re a few weeks ahead of me I look forward to seeing how you progress. Best!

Comment by annababi 07.10.14 @ 7:10 am

Especially if you’re non-op, make sure you don’t fall behind /Cecilia/ protocols, including PWB @2-3 wks, FWB @~4wks. If you’re post-op, going slow is still useless and a PITA (& embarrassing - going slower than the non-ops?!?), but not dangerous.

Comment by normofthenorth 07.10.14 @ 10:47 am

What is it like when you are pwb. How do you go about training that up towards fwb.

Comment by chris89 07.10.14 @ 2:16 pm

Thanks anna & norm.

chris - pwb is walking in the boot using the crutches very lightly, like training wheels on a bike (Norm chime ins here). I’ll walk short distances without crutches in the house and I have a worksheet of daily home exercises I follow. As DavidK mentioned earlier the biggest challenge is mental. I was scared the first FWB steps, since then I’ve been fine. Everything done without pain of course. Happy Healing!

Comment by eddienomura 07.10.14 @ 4:27 pm

PWB covers the whole range from NWB to FWB. It starts with virtually no wb, with the booted foot resting on the ground/floor and only pretending to walk. Gradually it bears some weight then more, and eventually one forgets where the crutches are (=FWB). That transition typically takes a week or two, though people in the first day or two don’t believe it!

Comment by normofthenorth 07.12.14 @ 1:31 am

Hi, I’m in UK. Full rupture 13 May 2014. Non op. Cast equine for 2 wks then as I couldn’t bear a full cast Dr forced my foot in neutral, no wedges, into big black Ossain boot. 2wks later allowed off to wash and sleep and partial weight. I’ve never managed to put much weight on it in this boot, too painful. At 6wk appointment he briefly said it was healing and referred me to physio’s.
Seen physio twice. Got stretch type exercises and can partial weight with own shoes and 1 crutch now I’m almost 9wks.
Why am I still feeling it too tight and painful to ditch the crutches and FWB, either with boot on or shoes?
Help please, I’m getting worried. Thanks

Comment by Lydea 07.12.14 @ 8:46 am

Lydea, forcing a non-op ATR ankle into neutral at 2 weeks in is Cruel and Unusual Punishment, and shouldn’t be done by anybody, least of all somebody with a degree from Medical School and a license to practice. Check out the three most successful non-op studies and protocols — 2 of them from the British Isles! — at achillesblog.com/Cecilia/protocols .
I obviously can’t tell what state your ankle and AT are in now, and I don’t have a clear (non-professional) opinion on what your best option is at this point either.
The good news (and it is news) is that Wallace in Belfast (one of those three studies you can read via Cecilia) got excellent non-op results on a group of stale, neglected, chronic, misdiagnosed, or mistreated ATRs. A few of them would not “approximate” — i.e., when extended in equinus, the two torn AT ends would not meet — so Wallace sent them for surgery. But most would, and their non-op results were excellent, as good as the ATRs that were treated promptly.
That surprising result means that even if your AT has failed to knit properly into a single rebuilt AT (because it was foolishly stretched into a neutral boot weeks too soon), a good practitioner could still follow Wallace’s technique to bring the ends together, and your prognosis would be very good. A bit delayed compared to getting Wallace’s (or Exeter’s or UWO’s) treatment from the start, but still very good.
Me, I wouldn’t trust that same doctor to do the job. Too much reading to catch up on, and he’s probably not motivated to start.
BTW, when you say you “couldn’t bear a full cast”, are you saying that he wanted to put you in a cast that covered your knee?!? If so, that’s also Cruel and Unusual Punishment, very far from Best Medical Practice or anything remotely Evidence-Based.
Many of us have commented repeatedly here that ATR treatment is extremely varied, around the world, in individual countries and regions, and even in individual medical centres. Still, it’s sad that a citizen in the UK can get medical care that is so many decades behind the world-class care practiced (and published) in Exeter and Belfast. . .

Comment by normofthenorth 07.13.14 @ 12:50 am

Thanks for replying Norm. I’ve checked out the recent studies.
And, sorry Eddie for invading your blog.
I was equine front cast within 2hrs of badminton injury but ultrasound 2 days later perhaps ripped any healing as it was torture. Seems rupture was high, at muscle, and ortho Dr said surgery would be complicated. I’d try anything rather than surgery so was fine with that. After 1wk they put a full knee to toe cast but I couldn’t stand the restricted tight almost claustrophobic feel. That’s when at 2 wks Mr Eslami got the nurse to force my foot in the boot (it’s actually for a male UK size 7-10, I take a 4!). I asked about the wedges, she said NO, Mr Eslami wants no wedges in the boot. Boot on 24hrs for 2 wks NWB, then 2 wks PWB and off at night. So 6 wks at that ortho clinic then passed to physio’s care. Which I was actually glad of but physio does not get my notes or the ultrasound. She did do the test and palpated it as had the ortho Dr and said it seemed complete. I can do the exercises but since starting them my ability to walk without the boot and 1 crutch is almost impossible. Lots of pain where I imagine the AT joins the muscle, even tender to touch.
I have an appointment with my own Dr, my General Practicioner on Tuesday. Do you think this is the point I request a consultation and examination with another specialist? I’m so disappointed, I’ve done all that I was advised. Thanks again Norm and this great site.

Comment by Lydea 07.13.14 @ 4:50 am


I just looked up the Exeter study (the abstract) and that gives the names of their consultants plus their results. Your OS or GP could confer with them, although I don’t suppose they will - professional pride seems to trump new learning, and time passed by now.

bjjprocs.boneandjoint .org.uk/content/95-B/SUPP_18/16.abstract

Comment by atrbuff 07.13.14 @ 1:11 pm

Hi Lydea, Sending positive vibes your way!

Comment by eddienomura 07.13.14 @ 6:33 pm