@4 weeks-FWB in boot!

July 3rd, 2015

3 July 2015 - R+27 days (non-op path)

After dabbling on and off with PWB over the past week, I called my OS yesterday to ask for a clearer picture of what “weight bearing as tolerated” on weeks 4-6 of my protocol meant. I was just a few days short of my 4 week threshold, and while I certainly did not want to over-do it, the idea of putting crutches aside was enticing.

My OS told me that, so long as I was not experiencing pain and not over-doing it, I could put as much weight on the injured leg as I wanted.  Over the course of the day yesterday, I experimented and built-up in WB with one crutch and eventually found myself walking (more on my current definition of “walking” later) crutch-free.

I keep all weight on the right/injured foot directly on the heel.  I tried copying the Brady Browne “Zombie walk” (see Youtube if you have not already… I found his videos quite helpful) with my injured foot canted outboard to avoid rolling onto the toes… but my knee did not like the lateral pressure so I ceased using that technique.  The up-side of the cant was being able to let the injured foot pass behind me for a stride length that was approaching “normal-ish”… but since my knee didn’t like that on day one I was not going to keep doing it and risk causing other issues.

Instead, I have become a homo-sapien inch-worm.  My right/injured foot goes forward, and then my left comes up to join it.  Repeat as necessary until the destination is reached.  It is a slow way to get around, but within the apartment I have plenty of time.  The up-sides are huge: 1\ I can CARRY things.  2\ It feels like a huge milestone along the long road back to “normal”.

I had another PT session this morning, and took the crutches with me for two reasons: 1\ The hospital is on a hill, and I am only proficient and inch-worming on a level surface at this point in time.  I want to avoid risking any surprises or unnecessary pressure on the AT by negotiating a hill in the boot right now.  2\ I can move much faster with the crutches than I can using my inch worm walk.

My Physical Therapist was pleased with my progress.  She had me do a lot of active movements (full extension in plantar flexion “free” {amazing to again see evidence that the calf IS connected to the heel bone}; up to 0 degrees “free” and against resistance; inversion/eversion “free”, plus a number of upper leg and knee exercises to start building strength), and manipulated the foot a fair amount.  Generally, I the manipulations felt fine, but I’m still apprehensive about dorsiflexion movements that run into the “tension limit”.  She seems to be very understanding about the fact that I have difficulty relaxing for that movement… I suspect I am not the first to feel that way.

Overall, this week was HUGE for me.  First: Actively pointing my foot away from me was hugely gratifying after only a month ago “failing the Thompson Test” and having lost that ability.  Second: I can WALK now.  Sure, it’s a baby step, inch-worm movement, but I don’t care.  I am vertical without crutches, without any pain, and can roam around my apartment while carrying things.  Life just got a whole lot more livable.

I just ordered an “Evenup” shoe balancer to wear over the shoe on my “good” foot, and look forward to taking it for a test drive once it arrives in a couple weeks. (I learned about the “Evenup” from a thread on oscillot’s blog.)

http://www.amazon.com/gp/product/B006IUU2TK?psc=1&redirect=true&ref_=oh_aui_detailpage_o00_s00

When I was initially researching, I found myself reading medical studies for hours before I came across AchillesBlog and the wealth of information that is here.  Important decisions and actions are taken in those first few days.  So, in an effort to share with folks who are looking for answers soon after injury, I uploaded a video to YouTube today at: https://youtu.be/Bw6wktBPuPQ

Thanks to everyone in this community for your posts and feedback.  Your insights and simple sharing of your own experiences help me made informed decisions, and make me feel a lot less alone on this path.  My family is with me, but while they are doing an amazing job of supporting me, their burden is different than the one before those of us healing from this injury.  I am grateful for having you out there as my sounding board.

UPDATE: Case in point regarding this community: Many thanks to Donna for sharing the following instructional video on the proper way to walk in the cam walker boot.  https://youtu.be/4kGY4VBHqq8 I will start working up to rocking forward today!  Thanks also for the tips regarding the use of a compression sock during the walking phase and modern icing systems… I will look into both (since I still have plenty of time on my hands with my foot elevated most of the day… above my heart as often as I can).  Thanks again!!!

  1. bobfv Says:

    “Homo Sapien Inch Worm” :) Glad you are able to get around better, congrats on FWB! I still carried at least one crutch when going out in public for about a week after I went FWB - now (6.5 weeks) I venture out without the crutch. Good luck with your continued recovery.

  2. Ed Says:

    Hi Evan! This is great, I’m following same protocol as you, this gives me so much hope to be able to be FWB at 4 weeks, I’m hoping I can do that, but as a I re-ruptured I may be following a little more cautiously, but I’ll check on your blog to gather information. Keep up the healing my friend!

  3. ejbvmi Says:

    Thanks, Bob!
    Ed, Best of luck and do continue to take it slow. I am mindful of the risks and did not anticipate walking without crutches so soon after starting the progression from PWB… but it felt fine with all the weight going onto my heel and using my short steps. I am enjoying this milestone and am in no rush to push to a longer stride just yet. For a visual, skip to 9:36 in this video: https://youtu.be/Bw6wktBPuPQ
    -Evan

  4. mattycee Says:

    I’m 1 week since rupturing my left achilles tendon and I am glad I found your post and video as its the same way I’m going with the nonsurgical route. I’ve got a hinged can boot set to 30 degrees and the surgeon said he will try and go to a neutral level when I go back to him on the 15/7 which is only 2 weeks.
    Seems most others have done this later than that.

    Could you walk OK on it before you got the boot? I could “walk” totally pain free but was a strange sort of limp.
    Mine really hasn’t been painful to be honest and that’s why I chose the nonsurgical way.

  5. ejbvmi Says:

    @mattycee: Oddly enough, the inch-worm walk I am using now in the boot at 4 weeks is roughly the same way I walked into the Emergency Room. I couldn’t allow my injured foot to pass behind me after the injury me because I could not push with the calf and AT.
    Mine hasn’t been all that painful either. I took ibuprofen for the first few days to help with swelling, but that was the only medication I have had to date. In the first couple weeks, the rupture area would throb a bit when I lowered my foot from the bed after waking each morning, but that was the worst of it.
    Best of luck with your recovery, and take it slow. Patience is not my strongest characteristic, but it seems to be a mandatory requirement with this injury. -Evan

  6. donna Says:

    Hi Even…I am at 8 months post op. I wanted to note a few things for anyone who watches the video you made.

    I couldn’t see clearly but it looked like you were elevating above the heart. That is the most effective form of elevation to control swelling. As you get more mobile with FWB a compression sock is very helpful because most people swell more. As for icing many of us have to ice well into 4 months or beyond (I had to ice into my 7th month) so as a FYI there are modern icing systems out there that are more effective, convenient, and not too expensive than the good old fashioned ice pack you’re using. As for FWB in the boot…as you progress you want to rock forward by pushing the shin forward. As it stands now if you continue walking as you are it will impede proper body alignment. The boot was mean to rock n roll. There are YouTubes on how to walk properly in the boot. I’m sure if you search you can find one. Big smile for you.

  7. donna Says:

    https://www.youtube.com/watch?v=4kGY4VBHqq8

  8. ejbvmi Says:

    Thanks very much, Donna! Comments like this are why I appreciate this site and our “comrades” so much. I have updated my post to include this information, and will start shopping for a compression sock (if you have a strong recommendation for a particular brand, please let me know) and modern alternatives to my old school ice pack today. I’ll also start experimenting with rocking forward in the boot. Not that my atrophied calf muscles are strong enough to pull anything loose at this stage anyway, but I was so excited about ditching the crutches that I didn’t want to get greedy and push it yesterday. Congrats on making it so far! It must be nice to see so much of this journey in the rear view!

  9. ejbvmi Says:

    @mattycee: Something worth mentioning to a fellow non-op option dude, just in case you run across the same issue: One thing I experienced when I had my foot out of the boot for extended periods (usually for ice, and sometimes I left it out to breathe… it has been rather hot here and we do not have air conditioning in Germany) was that when I put the boot back on there was an uncomfortable amount of tension in the AT rupture area. It appeared that my foot’s natural angle out of the boot was further from neutral than the boot angle, and that while outside the tendon may have been healing at the shorter length at that steeper out-of-the-boot angle. I certainly did not want to force it, so took my time putting the boot back on and gradually worked my foot back to the boot angle (2 cm heel lift, ~20 deg) like a pre-run stretching regimen. I.e. stretch gently, release, repeat… and eventually the foot was comfortable at the boot angle. After that, I focused on maintaining the boot angle as much as possible, even when the boot was off.

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