Issat’s Achilles Snap

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If the sandals fit properly as they should, they are not really any different than shoes. I have a pair of Teva sandals that have several adjustments on each one and I can and have run in them. I had a pair of Merrel sandals that I finally gave away because I could not get them to fit my feet snugly. Sandals that are loose and floppy are, at least to me, not only comfortable but also dangerous because they may not always provide proper support when they should.

Issat- Are you at all concerned to be walking aroudn the house in sandals? I read of a re-rupture partly due to sandals. it happened in the house as the sandal was caught on a stair. I dont know how long out the man was but wow that would really stink.

So your boot will go 10 degrees up PAST NEUTRAL?? I always had mine stop AT neutral. When I was getting ready to stop ever using it, I set it to hinge past neutral, and it didn’t feel good to me, so I put it back.

Have you tried rolling your heel around on a golf ball (while seated)? It seemed to help my heel pain some, after my PT recommended it.

In addition to direction and massage and such, most PTs also administer treatment with high-tech gizmos that may (or may not) help: electro-stimulation aka “difference currents”, lasers, and ultrasound. Some of them have been tested on general pains and injury recoveries, though maybe none on ATR recovery.

You need to recover ankle stability and balance, and build up your AT and calf strength. The former can be done fairly aggressively as long as you’re sensible (like balancing on one foot, but in a doorway with your eyes open!). The latter has to be done gently and with caution while your AT is still healing.

The only “trick” I got from my PT that wasn’t obvious to me, is that using the calf (plantar-flexing) with a straight knee, and with a bent knee, works different parts of

Tony’s got a blog now!

So are there two Allen setscrews on each side, in a slot? One that limits dorsiflexion and the other limits plantarflexion, and you can move them around (when loose) then tighten them so they stop the hinge from going past that point?

My hinged boot (Donjoy MC Walker) has only one Allen setscrew in each hinge, and all it does is lock everything down, like a fixed boot. Everything else is done with a couple (2/hinge) of pins that stick into a wide array of holes, each at a different ankle angle. And there’s a clear plastic rotating cover over the whole mechanism, partly to make sure the pins don’t accidentally get knocked out or pulled out. It works pretty well.

norm, the CAM Walker can be hinged in plantar and dorsiflex at any degree.

It took a while fiddling with the alan key. For the past few days i’ve found myself walking around the house with the alan key in my pocket to adjust it.

I’m still getting this unbearable pain in my heel!
I’ve got enough heel cushions to sleep on.

Have you come across any other foot/calf exercises aside from the normal stuff?

Tony, things are slightly different here in the UK. In fact treatment varies from one primary care trust to another and hospitals in the same trust.

While patients are treated under a particular consultant, it happens that you may be seen to by 5 different consultants but not the one you’re registered under! Each belonging to a different school of thought with regards to treatment options (op, non-op, boot, cast…)

Your consultant is an asshole; he obviously doesn’t like being told what to do, esp from patients! Any chance you can see another consultant at the same hospital, try booking a different day slot.

I’m careful not to encourage you to wear the boot, in the event he removes you from his care, which happens in the UK. You will forfeit any physio

Let us know how you get on.

Thanks, Tony, and I’m glad you got your blog working!

Norm thanks for your consistent replies. I am slow to learn how to work the site and my blog. I will figure it out. I hope you realize how encouraginng your posts are. You know what our coaches always told us. It is how we look at things that most affects how we perform. This blog helps to have the knowledge to formulate a good perspective and context in which to operate.

So issat, you can set your boot to hinge freely in the downward (plantarflex) direction, while it stops at (say) neutral in the upward (dorsi-) direction? If so that’s great. I’m not sure anybody knows for sure exactly when an ATR ankle — post-op or post-non-op — is optimally ready for that hingeing. I got mine hingeing (post-non-op) at 7 weeks, which certainly felt fine and worked fine.

My only “problem” came soon afterwards, when I spun around when walking very fast, and started walking BACKWARDS very fast. That’s MUCH harder on the AT, and I stopped right away, fortunately without pain or injury or setback. (But I scared myself silly!)

Tony, I see that Dennis has created your blog, but it’s still just the standard initial “form-letter” text, which you’ve got to delete and replace with your own story. D’s e-mail to you should have explained some of the details. Basically, I think you sign in, go to that page, then hit one of the appropriate commands, like Dashboard or Write or Edit or some such. (I usually start from Dashboard, myself.)

And Tony, all your questions are excellent ones, and I don’t have any excellent answ

All,
I dont know how to create a blog but have followed all comments. i emailed to try to create a blog.
I ruptured my tendon playing basketball about a month ago. Had surgery two weeks ago. Just got my splinnt removed and casted.
Had surgery before being acquainted with the blog.
After hearing about the VACOcast boot i wanted to move to it instead of cast.
My O Surgeon would not look at, touch or talk about the boot. He does not know me, has barely spend more than 10 minutes with me and said i would take it off. He refused to consider the boot which i had purchased and brought to show him along with several studies.
I am left wondering what to do. Should I find a different surgeon and finish this process with him in the boot. How would i do that and what are the downsides? Or should i stick with his program which is 4 to 6 more weeks in the cast. I really couldnt get a straight answer about what comes next. Is it 4 or 6 weeks?
I live in Kansas City but am open to travel. After discussing with DR friends i have discovered it is unlikely to be taken on by another surgeon post surgery.

I was wrong! The CAM Walker Air boot does hinge at varying degrees. Just tried it and works well.

My PT suggested sitting down, barefoot, with a golf ball under that heel, and rolling it around to do some deep self-massage. It seemed to help some. (If a golfball is too intense, look around for something appropriate, maybe a tennis ball. . .)

Many of us tried, and loved, the ugly molded shoes called Crocs. Wearing a pair of them is a lot like carpeting your whole house in ~1 cm of cushy foam rubber! I’m still wearing mine around the house, and may never stop (unless I buy a pair of Vibram 5-fingers!).

I think the hinging (hingeing?) of a hinged boot is worth a lot, especially in the tricky and risky-scary transition from a boot to 2 shoes. A hinged boot gives almost all the protection of a fixed boot, with a lot of the benefits of “2 shoes”. Specifically, the AT and calf can work through their full healing-appropriate Range of Motion, while still being protected from being overstretched with “passive” dorsiflexion.

I.e., if you step on a step or a bike pedal or a curb with the ball of your foot, the boot (unlike “2 shoes) will save your AT from being overloaded. But you can still “step off” at the end of each stride, similar to 2 shoes.

You’re also way better protected from being tripped in crowds, etc., and especially from being hurt even if you are. On the downside, all the smaller ankle-stability and proprioception muscles and nerves and ligaments are still being sheltered rather than the way they’re “worked” in 2 shoes.

Of course, you can get all that protection in a fixed boot, but then you’re eliminating most of the calf-and-AT work you can get in a hinged boot.

No, cant hinge.

Issat, can your boot be set to “hinge”, letting you plantarflex way down, but protecting you from dorsiflexing past neutral? It looks like it can be adjusted so it’s “fixed” at different angles, but maybe not hinge.

Tony, the VacoCast can definitely hinge, as well as being fixed at different angles, at least with add-on wedges. Gunner is one of its biggest fans here, you can check his blog for more.

I was put into a Donjoy MC Walker boot, which looks a lot like the Chaneco Pin CAM® (Adjustable Ankle) Air Walker pictured at chaneco.co.uk/products.php?product_id=709. It can also hinge freely through adjustable angles (or be fixed at different angles).

are you familiar with the VACO cast? If so i wondered how it compared to the one you have shown here.

It’s good you took charge to get the boot. Now you should take charge to get your protocol speeded up to (at least) a more modern one that’s been proven to be effective. I’ve posted one at bit.ly/UWOProtocol that produced excellent results in about 150 patients, half post-op like you, half non-op like me.

BTW, if you had focused your reading of studies on the ones that were randomized and prospective, and done since 2007, you would have found that THEY found IDENTICAL re-rupture rates (and strength and range-of-motion) for a modern fast protocol WITHOUT surgery, compared to the same protocol with surgery! That’s why I skipped the surgery in December, for this second ATR. I’ve posted annotated links to those studies at bit.ly/achillesstudies , and I also inserted a couple of paragraphs (and 4 reference links) into the still-current Wikipedia article on AT rupture.

The rest of your experience sounds like you fit in very well in this crowd! Now get your foot wiggling, and get into Physiotherapy, and get weight-bearing. . .

Thanks for the informative insight!
Have you tried walking unaided with boot?
Do you have any pictures of it?