Cast Is Off! Can you share you experience with me please?

Hey Achilles recovery crew, so it’s a milestone in my recovery so far. Cast is off and Vacocast boot is on. So far I definitely like the boot and my doctor/nurses were pretty impressed with it too.

I had my cast on for 5 weeks total (2 weeks cast #1 then 3 more weeks cast #2). The whole time I was non-weight bearing. Now my doctor says I can do weight bearing as tolerated (non partial weight only). It’s going to be partial only in the beginning but to have the ability to put my foot on the ground when sitting is a relief to me.

Here is what he has instructed me and this is where I would like to hear your experience as well.

- Start physical therapy right away, he would like my foot to be at neutral position by 2 weeks from today (1/6/16). So that would be on 1/20/16.

- My foot is currently at 30 degrees planter flexion and he wants me to keep it like that until my PT gets my foot to neutral during therapy. He didn’t mention anything about gradually changing the angle in the boot. This is a little weird to me since it seem most people make gradual changes in the angle of the boot as they go on. He wants the boot at 30 degrees for the entire two weeks and then if my PT gets my foot to neutral position within 2 week during the sessions (or when I’m home), then I can just move the boot from 30 degress to neutral. Did any of you do this?

- Then I am to continue my PT and see him 4 weeks from today (2/3/16). He said if I can’t get my foot to neutral by 2 weeks from today then I should call him.

- Called the PT that I want to go to (they work with athletes) and they can’t take me until 6 days from today! What should I do until then. He told me to start right away. Should I do the basic exercises I see on YouTube or read that people do when they are first able to do PT?

- I’m participating in a Achilles study with the University of Delaware PT department and they are going to be Ultrasounding my achilles tomorrow. Maybe I can ask them things to do for now.

DEAD SKIN ON FOOT:

My foot is flakey, dry, hard, and with dead skin. What did you guys/girls do to help with this? Today I did a foot soak, washed with fragrance free body wash, and put fragrance free lotion on it.

SHOWERING:

This part is actually scary. I was excited to get the cast off and have the ability to clean my leg but to not have the comfort and protection when in the shower is pretty scary. Do you have any showering tips when you have nothing on your recovering leg? I have a shower stool..It’s harder to prop my leg up though without the cast or boot on.

FEELING IN MY FOOT:

Did anyone feel like their foot was numb? My cast is off and when I feel my heel on it directly or on the side it feels numb. It’s also numb around the incision site.

As I get more experience and learn myself I’ll share as well. Thanks you in advance to anyone who comments and shares their experience.

11 Responses to “Cast Is Off! Can you share you experience with me please?”

  1. Jasculs, congrats on the boot! It is a milestone and things are going to get better and better for you from now on. Your doctor’s protocol sounds a little weird but I don’t think you should be too concerned about it. The most important thing now is to start bearing weight. The higher the angle of the boot the less strain / force on the tendon. So if your doctor wants 30 degrees while you bear weight for the next 2 weeks, then stick to that. But you must bear weight, as much as you can handle, since this will assist the remodeling phase of your recovery. 30 degrees is very steep, I was at 15 degrees at 5 weeks and the Vacocast protocol is already moving to 10 degrees and lower by then. But only your doctor knows what type of suture was used to join your tendon and how much strain / force it can withstand, and only your doctor knows what your tendon looked like during surgery. So if he says 30 degrees for 2 weeks, then do it. Since you can’t see your PT for 6 days, I would recommend starting what’s called “active ROM”. Active means that you move your foot only by using the muscles in your injured leg, you don’t try to use other muscles to pull or push on it. This means no stretching with a towel or using the floor or anything like that. Just use your own leg muscles to move the foot up and down, side to side and in circles. Lots of us write the alphabet with the injured foot. You’re still in a recovery stage where the collagen is being laid down and you don’t want to over stretch the injury site because this could lead to a lengthened tendon which could lead to a loss of strength later on. I think the most important thing to note is that although you want to do everything perfectly on time now and as quickly as possible, it doesn’t make a difference later. If you only start PT at 6 weeks instead of 5 then your recovery will not be impacted. I’m not a medical person and I’m not qualified to say this, but I think that the most important thing you can do right now is to work up to walking on that leg in the boot. Do the active ROM and bear weight and when you see your physio in 6 days then he/she will be able to guide you further.

  2. Wow! Thank you Beanie for all the details and explanations you gave Jascul, and that also help me!
    Jascul, bathing is an issue, but I’ve been bathing for almost two weeks daily now, and have some comments.
    A rotating stool is recommended to facilitate moving, but my tub is too small for it to be useful… A high back shower chair is also recommended, but it would not allow me to lean back into the shower and get lots of water down my front.
    A hand held shower attachment is very comfortable, but getting one that fits on your bathtub spout might be a problem… so I’ve used plastic cups, loompfas (did I spell that right?) and even a wet sock to clean and rinse my foot. Now, I got a removable, suction cup support handle to put on the shower wall tiles, and it helps with my balance, though it can come loose. With the support I can lean back even more and get the water running down my leg.

    While bathing, since I have shower curtains and a tub, I rest my injued leg’s knee on the tub edge, over the curtain, and i am stable as I shower and cleanse the leg. Lifting the uninjured leg is tricky, though… Reminds me of circus acrobatics…. :-D

  3. Like Beanie said. I am a bit concerned about how the PT will get you to neutral in 2 weeks considering you have not had the foot move for 5. Too much passive stretching this early is not helpful. Bearing weight with the boot at that angle will also be awkward so maybe you can get the PT to adjust the boot angle and put a couple of wedges under your heel to increase the angle. This will give you a flatter sole on the boot and take a bit of stress off your knee and hip. If you are part of a study then you should follow directions as this may be important for them to assess outcomes.

  4. Here’s what I did about bathing: While wearing the boot, I put my good foot in the bathtub, and, straddling the tub, went down on that knee. I then removed the boot from the injured foot, and brought the foot into the tub, never placing any weight on it. I then took a shower on my knees.

    When I finished, I dried as best I could on my knees, put the injured foot out (carefully), placing the knee on the bathroom floor, and lifted up to sit on the rim of the tub, on the the toilet seat cover, which is very close by. I then got into the boot, and finished drying.

    It took a day or two to get the hang of it, but then it worked out really well. Good luck with it.

  5. Hi jasculs,
    I want to comment on one of your points: lack of feeling in the foot (numbness).
    This is something that I clearly remember during healing!
    My foot was particularly numb at the heel, on the outer edge all the way to my little toe, and on the metatarsals. It was not numb along the big toe or the inner edge. The numbness lasted for several months. If I rubbed the tendon I would get this strange feeling on the toe, as if glass shards were inside and moving.
    My doctor said it was a common occurrence due to surgery irritating the Sural nerve and other minor nerves. Eventually the numbness subsided.

  6. Just wanted to add that I had a hinged ROM walker boot. At the beginning of my third week post surgery until the 8th week the boot was set at 30 degree planterflection to neutral. At eight weeks I came out of the boot and back into two shoes and no wedges.
    I was encouraged to walk in boot as soon as pain could tolerate.
    So pretty much once I got the technique I was walking unaided in boot.
    I questioned the 30 degree and if it had to be altered but he insisted it stays at that until the 8 th week.
    He said it encouraged a normal motion and with his suturing technique this is what he recommends. When boot was off I basically did the exercises beanie suggested in her response above until I was given the new sets given by my physio at 8 weeks.
    To date I have had no set backs and my progress is on track. We have all experienced different protocols & recovery instructions and we are all doing well, just wanted to let you know I was set at 30 planterflexion and neutral, it worked out just fine for me.

  7. Hi, I’m not sure if this is the proper place to post but thought I’d give it a shot.
    I had surgery on 12/29/16 and just received (1/15) my first fiberglass cast. I find the cast very tight at the top of my foot - is this normal? I was very close to going to minor emergency to have the cast removed last night as it was very difficult to sleep. I’m again struggling with the question of going to have it removed then re-casted Monday. Just wondering if anyone else has had the same issue and what your action taken was?

  8. Hey there yes I was in your camp… I had it tough at night. At about 4pm the top portion and leg tightened almost like swelled and felt so tight with cast .. I had some sural nerve issue which is the nerve by the Achilles (affects the outer portion of leg / ankle to baby toe and one next to it) … I got ambien which was a g-dsend .. Don’t get addicted … It helped get sleep .. I wa told at night it is normal just like fever spikes at night so does pain … Hang in there .. I am 10 weeks post op and it feels like light years from where you are .. It will improve .. If you have pain all the time ask your Os

  9. I ruptured my achilles in Sept and then 10 weeks into rehab, I re-ruptured it by doing too much too soon. The first time I had surgery and the second they just immobilized for 5 weeks. It’s been much easier the second time around but I definitely learned a lot.
    1) Showering- I had a walk in shower with no seat. I used a folding metal chair (the true shower chair felt too shaky) that I lined up with the door. I set up another chair perpendicular to the shower and basically use the two to get in. Once I’m in the shower, I take off my boot and then turn on the shower. When I’m done, my hurt leg is the first to get dried off and the boot goes back on immediately. Then I shimmy to the other chair so I can stand up easier. It sounds silly but it’s the only way I can make it work. Also, the Curad cast covers have been awesome and have never leaked.
    2) PT- the first time was very aggressive but the second time was more conservative. I was in a NWB cast and boot for the first 5 weeks. During the 6th week, he had me transition to FWB within a week, keeping my Vacocast at 20 degrees. Then, he had me reduce the angle by 5 degrees every 4-5 days until I’m at 0. PT started week 7 but in the meantime, I would just take my foot out and do toe circles in the air and move side to side. I barely try to stretch it since I went non-op the second time around. My achilles has felt SO much healthier doing it this way. I loved doing the FWB while in 20 degrees. So much simpler than trying to do both.
    3) Dead skin- you can just keep rubbing in warm water or with a wet washcloth. It desensitizes your foot anyway, which will be helpful. I went into the jacuzzi a lot, which helped with the dead skin issue.
    4) Numbness was a big bother to me during the first time around. A lot was from stepping on my heel first. I haven’t had that issue at all with the Vacocast and the second time around. Not sure why but I do try to be more gently with my heel stepping down and I make an effort to push off with my toes.
    Good luck!

  10. Great wealth of knowledge here. Thanks everyone for posting your experiences. Truly helps with my recovery knowing what others have gone through and I’m not alone.
    I tore my Achilles Tendon on 12/15/15 while in TX on a job. At first I thought I rolled my ankle and tweaked the calf muscle but it most definitely was not that. I flew home to NJ 2 days later and I was able to get into surgery on 12/21/15. I’m now 5 weeks post-op.
    I had my hard cast removed last week and was put into an adjustable cam boot with a 25 degree setting. I put in some heel lifts and padding around the lower calf as the boot was too loose even when I tightened with the straps. If i strapped the boot too tight though it became very uncomfortable so I suggest finding a good middle ground for your own situation.
    My orthopedist does not want me to put any weight on it aside from placing my leg on the ground until I start PT. I am allowed to do minor stretching on the injured leg and moving it feels good to start to try all of this. I think the biggest issue so far is the inactivity, I’m not one to sit around for too long. Seems that the best thing to do though is give in to the healing process and stay off of the injured leg per your doctor’s orders, my biggest fear is re-injuring because I got too impatient. I think it’s most important to heal correctly even if that means an extra week or 2 of immobilization, I don’t think anyone wants to screw up and hurt themselves all over again.

    I too was very surprised at the condition of my skin on my foot and leg once the cast was removed and I could look at it. I’m also concerned about the amount of swelling my foot and leg have. I also have been experiencing sharp pains and numbness in my heel and foot, mainly when applying lite pressure if I massage the area. When I examine or massage the areas it’s mainly the outside of my foot, below my ankle and the heel area.
    To help with the skin issues I have been doing a warm epsom salt bath with peppermint to remove the callous’ and hard dead skin as well to soften up the skin and help with swelling. I use a hand washcloth that is abrasive enough to wipe off the dead skin and it has helped a lot to remove it. After that I massage with a good moisturizing lotion or simple baby oil with no fragrance and then I put a compression sock on. The callouses have mostly come off and the skin feels much better. Good to read here the issues about the foot numbness and pains. I have not really seen many people address this issue. I only hope it goes away sooner rather than later.

    For the shower I initially used a cast bag over the cast with my leg sticking out of the shower curtain and a simple folding chair or plastic chair, this may be more difficult in a tub shower. I also got a suction cup handle that has helped me maneuver in the shower a little easier. I make sure to check the suction contacts before I use it so there are no accidents when I grab onto it. Now that I have my cast off showering is a lot better. I try to stand as it’s more comfortable for me and I rest my knee on the chair. I’ll sit down to wash the injured leg and rest the knee for a moment. It certainly is easier without the cast and having my foot out.

    I hope some of this helps and everyone going through the healing process comes out OK. Looking forward to simply walking down stairs and playing with my kids again!

  11. Sorry you had to spend the Holidays in a cast, Anthony. I was lucky to get my CAM boot (moon boot) on Dec. 23rd, and I certainly understand your impatience. I still have sitting in front of the TV, except for a very few programs….
    Good luck with your boot!

    Manny

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