Hard To Resist!

So as my calf atrophies my cast becoms more and more loose. I’m able to put 4 fingers down into my cast and rub my calf muscle… That feels great!

Still, there’s something else I’ve noticed… My foot has more room to wiggle around inside the cast, too…

Quite by accident I discovered that I can point my toe just a little bit…

Now, I IMMEDIATELY STOPPED as soon as I did it… I haven’t done it since… and don’t plan to until the Doctor say’s it’s ok…

But to know that my foot will point now means only 1 thing: The tendon is healing!!!

I couldn’t be happier!!! I want so badly to point my foot again and again and again… but more than pointing my foot, I want to NOT compound the injury, so I’m being good.

Just a small moment that brought me a lot of hope. :)

5 Responses to “Hard To Resist!”

  1. If you were in a boot, you’d be taking it off for the past 2 weeks to do gentle foot-wiggling exercises! In every direction except dorsiflexion = toes-up. So pointing your toes down is part of the best programs, like the UWO protocol I’ve linked on your page a few times already.

    You should show the best modern protocol and the associated study (with results that he may drool over). He didn’t get 100% in school any more than you or I did, and nobody has time to specialize in ATRs — except us ATR patients, of course!!

    If you were getting open-heart surgery, and you could afford it, you might fly to a big fancy Mayo-Clinic or Cleveland-Clinic place, to get the best medical care. With non-op ATR care, you can get World Class care anywhere, just by logging on and following the best recipe — but it’s got to be in a boot, not a cast, or your leg is trapped inside, and your PT is locked out.

    For now, start wiggling your foot inside your sloppy cast, and don’t make your leg wait until your Doc gets the memo from the 2009 conference of the Am. Assoc. of Orthopedic Surgeons! If not for yourself, do it for the next few dozen patients!

  2. Thanks for the encouragement.

    What’s the problem with dorsiflexion? If I’m in a cast and I try to pull my toes up, would that be a problem?

  3. I was in a cast rather than a boot, despite my waving the research and protocols at my doctor. Each time I was recast , the cast would become loose after a bit, partly due to my calf muscle wasting and to me wriggling around and moving as much as I could within the cast. You need to keep wiggling your toes as much as possible to keep the circulation going in your foot(helps to keep your toes warm too).
    I came to no harm wriggling my foot and ankle, in fact I’m sure it helped me to get moving again once the cast came off.
    You can’t really do any damage while you’re in the cast as your movement is so limited, so I say - go for it!

  4. I too wiggled my toes whilst in a cast and think it helped. Also it felt so good. I had my cast off at 4 weeks and it didn’t do me any harm. But you do what you feel comfortable with, this is as much a mental battle as a physical one. Carry on healing :)

  5. Icky, TRYING to dorsiflex in a cast, using your leg’s internal muscles, is not very risky. Most of the protocols say to stay below the neutral position for another few weeks — but iIn your cast, that position is guaranteed. The muscles and tendons that dorsiflex your ankle aren’t injured, or vulnerable, so exercising them in below-neutral positions should be fine..

    Your “best” chance at hurting your AT in your cast is by trying too hard to plantarflex, pushing the ball of your foot down. That move is primarily done by your calf muscles (gastrocnemium and soleus) pulling on your AT, which in turn pulls on the “calcaneus”, the place where your AT is attached to the back of your heel bone. At least in theory (and maybe in practice, too), if you could try THAT mmove hard enough, you could get your calf muscle to over-power your still-vulnerable AT. Muscle spasms might get you there, or an instinctive reaction to a loss of balance. (Instinctively, we’d all rather re-rupture than fall down!!)

    The hazard of dorsiflexion isn’t from TRYING internally (the PT folks call this “active” exercise), especially while your angle is limited by a cast or a boot. The hazard is from actually dorsiflexing past neutral too soon, especially “passively”, where the force comes from outside, like from your body weight, or a brute of a PT.

    If, say, you lose your balance while standing on your right leg barefoot, and tip over forwards, you would have the full weight of your body trying to dorsiflex your ankle hard. You would presumably also be fighting to avoid falling, by trying to push the ball of your foot down. Either way, there’s big tension on your AT at the same time as it’s being stretched longer. (The PTs call that “eccentric” loading.) Take that far enough, and it’s pretty easy to injure your AT, or even re-rupture it.

    That’s why barefoot balancing exercises should always be done in a doorway or a similar place, where there’s something to grab INSTANTLY if you start to lose it. Until you’re almost back to full strength, of course. That’s also why I like hinged boots for the last transition to 2 shoes. They can be set to give full freedom to plantarflex, while preventing dorsiflexion beyond neutral. Pretty full exercise, gait re-training, but also safety.

    The other fear of dorsiflexion is the fear of “healing long”. There’s an ideal length for an AT, and it’s pretty close to your other one, and pretty close to your former length. Initially, maybe especially post-op, you may start out shorter, and you’ll be instructed to stretch it out to get it back to normal. This makes sense, but only up to a point. Basically, if you go too far, and your AT heals too long, you may have a permanent functional deficit. In a choice between healing slightly short or slightly long, most experts prefer slightly short. (E.g., the surgeon who operated on my first ATR told me he made it slightly short on purpose, and it’s worked perfectly every since it healed.)

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