2 Week follow up
Thank God. I can’t wait to get this cast fixed or removed. Some of this nerve pain has to be related to my pinky toe being jammed due tot eh cast appearing too tight to me.
Over the past two weeks I have been relatively pain free except for my previously stated pain on the lateral side of my foot. Overall things seem to be going well. The swelling is way down and the surgical site is a bit itchy but nothing else to report really.
So the usual check in process happens then right to the cast room. I figured lets give this a shot. Could I please get a cast replacement cast? This one is too tight and driving me crazy. Once I explained what is going on, the cast specialist took a look at it and said well lets get you some relief and then I’ll talk to the doctor for you. That placated me for now so she immediately detected a wrinkle in it and decided to open it up around the toe area. Ah, I felt immediate relief! Next, she needed to cut a window out of the cast over the surgical site so we could access the sutures. This should be interesting since we have no solid reference point to figure out where to begin. Luckily my wife was there and said she was told it was lower than expected due to the rupture site. Now the real fun, you can’t get a blade guard back there due to the location of the incision and all. Overall it wasn’t bad and the blade only tickled my heel once or twice. Now for suture removal. Now mind you I never had stitches or staples before so I have no idea what to expect and I’m a bit of a baby when it comes to pain. I asked my wife to take a pre-suture removal picture for me which she did. Knowing I am a baby at times she wouldn’t show it to me until later. (I will put it in my media pages if you are interested in seeing it, not as bad as I thought.
I was assured I would feel nothing more than a pinch. 10 staples down and nothing felt. Numbers 11 and 12 were a bit sticky so I felt them but overall nothing unbearable. Now lets see the doctor. Well everything looks good I’m told and I explained the pains I am feeling. apparently I was right basic nerve pains partially caused by a snug cast and otherwise related to the recovery healing process. I asked about changing the cast but was denied. It was snug for a reason, it keeps my foot nearly 100% immobilized. I guess I’ll have to suck it up, at least it isn’t as bad as it was before. The procedure was explained to me. Apparently, it is a newer way of doing the procedure which is less invasive and should speed recovery and should be stronger than traditional methods. It is called PARS and is minimally invasive and is pretty cool. Check out the PARS link on the top of my page to check it out. It is not gory or anything but pretty informative. This method is used on pro athletes as well as Joe Lunch Bucket like me.
Well the window cut out piece was placed back in along with a antibacterial strip to be placed over the incision site to keep everything clean and healthy.
Take an aspirin (325 mg) daily to prevent blood clots from forming. Keep up on the Tylenol regimen to keep swelling down, continue to elevate and no weight bearing on the affected leg.
In 4 more weeks we will see where we are going next. that’s when we will decide on whether to put it back in a cast, put me in a boot or maybe just go the route of using a heel lift and going right to 2 shoes.
I’m hoping for the best but planning for the worst.
I’ve never heard that Tylenol controls swelling, pretty sure that’s Just Wrong. Never seen evidence of clinical benefits from 6 weeks of NWB immobilization, either, and I’m pretty sure there isn’t any. I wonder how your OS would respond if you told him you were a believer in Evidence Based Medicine, and could he share the evidence for your protocol producing good results? We’ve got a lot of evidence of great results from early PWB, from UWO and several other studies - including Exeter with ZERO post-op reruptures in a few hundred ATR patients!
The good news is that slow boring frustrating debilitating rehab doesn’t produce terrible outcomes post-op, the way it does non-op. But it’s still long-term pain for no (or negative) gain.
Going straight from a long immobilization to 2 shoes is also associated with high rerupture rates (at least in my mental database), so be careful what you wish for.
Norm,
After reading your post and doing some quick research I see what you mean. I’m thinking there was a miscommunication or misunderstanding. I see NSAID meds. I’m glad you brought that to my attention.
Sorry but you lost me with the abbreviation UWO as well as OS. I assume OS is Oprating Surgeon and PWB is partial weight bearing? Sorry, I’m still new to this.
I’m halfway through this “slow boring frustrating debilitating rehab” so I guess I can’t complain too much. ALl I truly care about at this point is recovering and getting back to my “normal” life.
Thanks,
Ralph
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Sorry for the confusing abbreviations, Ralph. Nobody’s born knowing any of them, but I think I was typing on a smartphone. . . OS = Orthopedic Surgeon (=~ Operating Surgeon). PWB & FWB are Partial and Full Weight-Bearing, as you figured out. UWO is the local abbreviation for the University of Wester Ontario (Canada) and their impressive 2010 study, which is available free on this site — and maybe nowhere else, unless you “rate”. Linked on the achillesblog.com/atr-rehab-protocols/ page, under Surgery vs. Non operative treatment (conservative treatment). I’ve also posted their rehab protocol at bit.ly/UWOProtocol .
That page also links to several other studies showing that early mobilization and WB — modern faster protocols — are either better or “not worse” post-op than older slower protocols (like the one you seem to be heading for).
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Norm - I like your posts more and more! Hang in there Ralph and I would take Norm’s advice and challenge your OS as to why you’ll be in a cast for 6 wks.
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