5 weeks down… PRP, PT, FWB?

The trip and the holidays made those 5 weeks NWB fly by.   I saw my ortho at the 5 week point and he was much more positive this time.  This time, my foot responded to the Thompson test and so there was a little cheer by everyone when it moved!  He was much happier with “the contour” of the achilles and said the thickening of the achilles that he expected was almost non-existent.  He wondered if that was a result of the initial PRP (Platelet Rich Plasma)?

We also talked about an additional round of PRP.  He said that it is unproven if it works but the feedback seems to be good.  He explained that I’d be casted again while my body goes through an inflammatory response to the PRP.  Given that they’d be injecting it into my achilles and there would be an out of pocket cost of $750, I opted to skip that process.  No thanks!

He did say he’d like me to start physical therapy after week 6.  I wasn’t able to get in to the physical therapy office until week 7 so that was delayed a bit.

Thrilled with the flexibility of the Vacocast, he gave me instructions on how to move to full weight bearing and then to 5 degrees dorsal flexion.  This time, rather than gradually going weight bearing over the period of 3 weeks while I was also adjusting the angle down to neutral, he wanted me to only focus on being full weight bearing within 5 days and then moving the angle of my boot to 5 degrees by the time I saw him again in 2 weeks.  This was HUGE to me and I would really recommend talking to your doctor about that.  It was so much easier and less painful to do it this way.  Within 4 days, I was full weight bearing but still at 20 degrees DF fixed and in the achilles sole.  Over the next 10-12 days, I gradually reduced my boot in 5 degree increments so that I was at 5 degrees DF fixed by the time of my next appointment, 2 weeks later.  Not that I ever want to do this again, but I wish I had this path laid out for me on the first go around.

All in all, he was pleased with how things were coming along and said he wanted to see me in 2 weeks and to start that PT.

9 Responses to “5 weeks down… PRP, PT, FWB?”

  1. Holly I think it’s great that you argued for the boot instead of the cast and won even though your Thompson test was failing, and that now you and your doctor can see that the boot was just as effective and you’ve been more comfortable through-out. It’s difficult to advocate for yourself and you’ve succeeded. Congrats! Awesome info in these posts too, thank you!

  2. Hi holly,
    I’m starting on my 5 week post rupture. I went non-surgery. I have a vaco cast boot. I have been fab for the last week. Although I had to stop due to swelling and pain. I. Back to fwb but not exactly sure if I should still have the large heel on or switch to the smaller one? Does anyone have a feeling of swelling but not really swelling? Just uncomfortable. Sort of like a numb feeling.
    Just seeing if anyone has any suggestions.
    Thanks this site is very helpful.

  3. Hi, Karen! Swelling that’s not really swelling… I think that is me. Mind you, I have had edema in my ankle for ages, so maybe I’m just used to it, but at 7 weeks, doing full weight in the boot, with one wedge, and getting ready for my fifth Physical Therapy session this afternoon, I regularly feel my foot is under pressure after walking a while, and it feels tight … and this is worse if I am wearing compression socks, driving me batty and making me cranky. Raising the leg helps a little, Icing the raised leg brings quick relief, and resting the foot by taking off the boot and sock while raising the leg helps a LOT.

    Being overweight results in lower back discomfort after walking around, too.

    But now, to your other question: about the wedge. First of all, a higher or thicker wedge protects the Achilles Tendon more, and my orthopedist will keep me on heels once I go to 2 shoes in a couple of weeks. (Scary… no ankle support!). I am taking my new shoes with inner wedges to my PT session today so they can help me gather confidence and practice over the next four sessions. As I see it, my Physical Therapy team are helping me and can tell me what is best to do. I am also taking a rubber tubing exercise thing-a-ma-jig (sorry Bonnie and Bobbie and Bryan… I don’t know the jargon) so they can explain how to use it for more than extending my toes under tension (dorsiflexion, is it?). Don’t know if they will want to charge extra, though… ;-)

    Yet another point for you to consider if you take public transport: some transport systems will recognize your temporary disability and give you reduced fares or other benefits while you (and I) are hopping around. At the very least they can offer information of alternatives that might help you.

    Good luck, Karen! And keep us posted on your progress.

  4. Karren, I remember having a lot of swelling type discomfort during that period. We were on our cruise and I just assumed that maybe I was scooting around more than normal. It wasn’t too easy to ice there so I really didn’t do that too often. I just tried to elevate as much as possible.
    That has since all gone away and I don’t have any of the swelling discomfort that I did then. I didn’t transition to FWB until week 5-6 so maybe you just did it a little early?
    I was told to stay in that big achilles sole until week 10. I know that’s later than some but after re-rupturing my achilles the first time, I’m being more conservative. I’m working out so my hip and knees aren’t bothering me so I figure I’ll keep on it until my PT tells me to switch.

  5. HI Manny,
    Thanks for your response. he only relief I get is also from the boot off and my husband gently massaging my foot. How long did it take you to go without crutches? I’m going to keep the large heel on until I see my doctor this Friday. She hasn’t ever dealt with the vaco cast so I’m trying to make sure I’m informed (through this website) as how I proceed.
    My doctor does not want any PT until 8th week and that makes me nervous too. I feel I need to be doing some little things to progress.
    What is your protocol? This is the craziest thing that has ever happened to me!! Sometimes it does get the best of you.

  6. Holly thank your for getting back to me. So, this is a re-rupture for you. I’m sorry to hear that. How did it happen? I’m new to this site so I apologize for asking.
    I’m trying to heal this the best way possible (like everyone) and I think you get better info here than the doctors. Is there a way to follow what you have already posted?

  7. Hi Karren
    I am non surgical in a vacoped, 10 weeks in.. i was fwb by 5-6 weeks but could not put the flat sole on until about 8 weeks when the boot was in neutral as I found it awkward to walk before this.

  8. Karren,
    I really think I was just doing too much too soon. I started PT 3 times a week at week 3. I was thrilled when I was driving by week 6 and then moving into shoes at week 8-9. I re-ruptured 5 days after ditching my boot (in my 9-10th week.) I just took a step up onto a curb in a parking lot and my whole foot wasn’t on the step completely. My heel dipped down and I felt it tear again. I was devastated.
    I went to 3 different doctors (Including my original surgeon) and all said my best option was non-surgical route. I have been much more conservative and just started physical therapy at week 7. This physical therapist isn’t stretching at all but is working on strength (to the point of my foot shaking at the end of the set) and a painful massage of the calf to loosen it up and my scar tissue. I really think you’ll be fine with not starting PT until now. I am happy I waited this time and feel so much better than the first go around.

  9. Hi Karren, I was similar to Gav and only tried the flat sole once the boot was neutral but I hated it because my knee kept hyper extending when I walked and it hurt the knee. So I just carried on with the wedge sole even at neutral. I walked faster and more comfortably with the wedge sole and my foot was still at 0 degrees so I figured it didn’t matter which sole I used. Good luck!

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