Good-bye crutches!

I can’t believe I would ever appreciate hearing that I’m allowed to walk! I went to see my specialist today and he gave me the go ahead to be FWB. I feel like it’s been forever!

He gave me the freedom to do whatever I like, suggested I continue wearing the boot as long or short as I want and as I gain some confidence (and coordination) get myself back into 2 shoes. I can’t exactly walk, I’ve tried. The boot I’m in was still not at 90 degrees so the tendon isn’t quite stretched out yet and I can’t stand up totally straight, but it’s a start I guess. For now I’ve adjusted it myself to what’s only slightly uncomfortable and am working on a sort of shuffle with one crutch… it looks ridiculous but I really couldn’t care less.

I’ve been told I’m ahead of my protocall. I wasn’t supposed to be weight bearing for about 2 more weeks. This is the kind of news I want to hear!

21 Comments so far

  1. norcalsurf70 on March 3rd, 2010

    Good news! If your recovery is anything like mine, you’ll be FWB and limping around the house in another week or even less. Take your time and be careful and your mobility will gradually improve.
    At 6 weeks post op, I’m officially in 2 shoes (ditched the boot today) and have been FWB for about 3 weeks now. I’m still limping, but my PT visits really help to stretch out the AT. Good luck.

  2. jenn on March 3rd, 2010

    A week or less sounds good to me… so far everything has been measured in months :)
    Was it painful at first getting back on your foot?

  3. normofthenorth on March 4th, 2010

    When you say you’ve adjusted the boot yourself to what’s only slightly uncomfortable, do you mean the heel lift, i.e., the plantar-flex angle? Now that you’re WB, the two ways of adjusting that angle are NOT equivalent. It can be adjusted by changing the hinge of the boot or by adding hard rubber wedges under your heel. Of the two, the heel wedges should be less disruptive of your standing posture and gait. (You still want your weight mostly on your heel.)

    The adjustment to FWB is bound to take a little while, though it usually goes quite quickly. And the transition from even 30 degrees equinus to neutral can usually be done in a week or two as well (preferably in stages), though your mileage may vary. My protocol started WB at TWO weeks, but didn’t remove any heel wedges until SIX — and then it said to withdraw them all at once! (I phased them out instead, MUCH more comfy!)

    You’ll find many reports here of people experience discomfort or pain when moving toward FWB — slightly cushy heel lifts and full-length cushy footbeds (including inside a boot) all help. It was only about a week ago that my “bad” foot got comfortable walking barefoot on hard floors, and those dimpled “massage sandals” are still unpleasant on that heel — and I’ve been FWB for about 7 weeks now!

    There are many little joys along this road, but becoming FWB and being able to walk normally and carry things around normally is certainly one of the biggest.

  4. "Frouchie" or "Grouchie", or just "Chris" on March 4th, 2010

    I know the feeling…we ALL know this feeling of finally being able to stand without aid. It took me about aweek to be totally free, but each person is different.

    Be careful and take small steps, NOT big long strides. We’re here for you should you need any pointers.

    “Slow and Steady Wins THIS Race”

  5. norcalsurf70 on March 4th, 2010

    When I first starting placing weight on it, it was slightly painful and had the pins needles thing. I was very unstable and cautious. Over the past few weeks, things have improved consistently and now I’m able to walk around with a limp pain free.

  6. maryk on March 4th, 2010

    I’m sure you know this- but the single crutch goes on the opposite side of the “bad” leg. I was doing it wrong at first! Congratulations on getting to a BIG milestone- it gets better faster and faster from here on out!

  7. jenn on March 4th, 2010

    I have a boot with an adjustable hinge, which today is now at a neutral position. I’ve already seen a lot of progress in only 1 day. I find it more comfortable to walk (with one crutch) in bare feet rather than with the boot which I originally thought would be the other way around. Going out where I have to walk farther distances I’m still probably going to be using 2 crutches for a couple more days until I get better at it.
    It is DEFINITELY painful at this point, especially when my PT stuck me on the bike today to try and get my range of motion going. It is also pretty frustrating for me because I hate saying “i can’t”, but there are things that I literally can’t do and muscles I just can’t activate yet because it’s too early. Being an athlete this feeling of being completely unable no matter how hard I try is foreign and really hard to accept. I understand that this is going to be the way it is for a bit so I just have to find a new mind set.
    Anyway, I’ve heard that it keeps getting better from here… not necessarily easier, but better. Will keep working hard!

  8. normofthenorth on March 4th, 2010

    Probably better AND easier, Jenn — let’s hope so!

    Do you know if you have any heel wedges in the boot? They often ease the transition from NWB to FWB. (Getting used to WB is hard enough for most of us, without having to get used to the neutral position at the same time.) And there’s no shame in using crutches — 2 of them, then 1 — until your foot is ready.

    I just realized that I’ve actually never gone into a boot when my foot was weak and sensitive and atrophied! First time, I finally got a hinged boot after my THIRD cast, which was a WB “walking cast”, so I was semi-used to WB already. And this time, I was slapped into the boot (instead of surgery) 2 days after my ATR, and I’d been gimp-walking ever since the ATR, FWB of course.

    The fact that you are close to being able to walk in bare feet, even with one crutch, is remarkable. The fact that the boot is LESS comfortable than barefoot makes me wonder if it’s set up well.

    Of course, one of the many blessings of having a boot instead of a cast is that you can get your foot out of it, for whatever reasons! Just don’t hurt it!

    Your PT had you on a bike in bare feet already? Before you were WB? Wow, how different these folks are from each other in the order in which they do stuff!

    I really would expect things to move along quickly now, over the course of a few days. If you still find it painful to put a reasonable fraction of your weight on your booted foot in two or three days, it might be worth calling somebody. (Or at least post here, to find out if others have had similar experience.)

  9. jenn on March 5th, 2010

    He put me on the bike the day after I was allowed to be FWB. It’s not like I could really go at it or anything, it was just another helper to get my AT a bit more stretched out because it’s got pretty far to go still. They were very slow and unsmooth pedal strokes : )
    I think part of the reason walking in the boot is less comfortable may also be because I JUST got to the neutral position and my AT isn’t quite used to the stretch yet, and while walking in bare feet even though I can take slightly bigger steps (almost one foot in front of the other… but not quite. And VERY slow) I can also relax every few seconds whereas in the boot it’s a constant stretch. But I guess if I can get comfortable with walking in bare feet then there’s nothing wrong with that!
    And you say you’ve ruptured both?? I totally can’t imagine. Hope you recover forever!

  10. normofthenorth on March 5th, 2010

    It sounds weird, Jenn, but this time is almost fun compared to the first time!

    I’m familiar with the routine, I still had crutches and a cane (and remembered how to use them!). And this time, everything went more quickly and with less pain and disruption, mostly because (a) I skipped the surgery and (b) I’ve been following a much quicker (and better researched) rehab protocol than last time, when I was constantly fighting with my “conservative” surgeon to get my rehab moving faster!

    Amid all the nuisance and disruption and discomfort, I’ve been overwhelmed by amazement and relief at how well and how quickly things have progressed, especially compared to the first time.

    Blogging alongside all of you fellow “sufferers” has also made this time more fun. Last time I read a lot on the Internet, but I don’t think I posted much. (This time, I can’t STOP!!)

  11. normofthenorth on March 5th, 2010

    And there’s another reason my second ATR rehab has been way more pleasant than my first. The first time, I was on uncharted ground, uncertain about my future, like most of the first-timers here.

    How long before I can walk, will I be ever able to ski again, run again, play volleyball again, hang out the side of a small sailboat on my ankles again, etc., etc.??

    Well, before 10 or 11 months was up, I’d done ALL those things again, and I did them as well or better than I’d done them before.

    So I’ve already seen the “light at the end of the tunnel” after a successful ATR rehab, and it was just fine for me. This time, with a nonsurgical protocol that’s been proven overwhelmingly successful in a fancy scientific study, I’m going through this with much more confidence than I had last time. Nothing is more troubling or more debilitating (maybe especially for a “jock”) than wondering if your health and fitness have been permanently compromised, and I’ve been liberated from that the second time — realistically, I hope!!

    I also have even more confidence in the Canadian health-care system than I did last time. (I’ve never even HEARD of a top surgeon, with many ATR repairs under his belt, talking a patient OUT of the surgery, because of the results of a new randomized study! How terrific is THAT!!) Of course, being in Toronto, I get to sample the very best of Canadian health-care, but still. . .

    I was born and raised in Boston, then moved to Princeton, NJ and hung out in NYC a lot. And recently, I’ve sampled a few Massachusetts hospitals with an ailing Dad. If I needed medical care, I’d choose Toronto with no hesitation! I don’t think “my fellow Amurricans” (as Nixon used to say) have any idea how much better their health care system could be — and that’s for the people who CAN afford it! (I paid $150 for my boot, which may or may not be reimbursed by private health insurance, and similarly with my physio visits. And this time I chose to pay big bucks for PRP injections, too. But for doctors and surgery and ultrasound imaging, I’ve paid a total of ZERO!)

  12. CoolKiwi on March 6th, 2010

    I’m with norm on the health system. Ours in New Zealand has its faults, but at least it’s all free…though of course you can opt for private health insurance and/or see a private specialist about anything you want to. I’ve done that in the past with other health issues, but friends in the medical world tell me that it would be a waste of time and money with an AT. Btw norm, my boot will be free too, as are the crutches, though obviously I don’t get to keep them :-) The downside is that there is no flexibility in appointment time and it’s a lot more difficult to get information out of anyone (outside the appointment). So I have a long list of q’s to ask when I go back tomorrow!

    What on earth happens in US if you can’t afford insurance? Is there a system in place which catches you?

  13. normofthenorth on March 6th, 2010

    In Canada we have to pay for our own boots and crutches (though we also get to keep them). And I think I also paid a few bucks for a bedside phone in the hospital! But we also get to choose our doctors and physios and such. I also haven’t had any problem getting as much access as I want — though this time, I haven’t needed much. I think second opinions are usually easy, too, though I’ve hardly ever done that.

    When it’s time to pay the bills, we don’t even get to see them. I wish we did, actually, so we could check that all the billed services were actually delivered. There’s probably some fraud and double-billing going on, and nobody ever knows, because it’s all out of the patients’ view. But that’s just a minor niggle against a great system.

    I forget how many Americans don’t have health insurance, but I think it’s many millions. Old folks get government coverage, and I think that really poor folks (like welfare recipients) do, too. MedicAid and MediCare, IIRC. But it’s not hard for the semi-poor or even the semi-wealthy to be bankrupted by long expensive ailments — or to be forced to choose their treatments based on the expense. (Mind you, in the case of an ATR, that could turn out to be a benefit, now that it seems that the “cheap” treatment is a good one.!)

    Meanwhile, Jenn, this is YOUR blog page, so please chime in on us “hijackers” and let us know how you’re doing with the boot!

  14. gunner on March 7th, 2010

    Norm or anyone: Need some advice: I’m 2 weeks into a cast after opting for nonsurgery. My good friend doc, old school, conservative has agreed to take the cast off after 3 weeks, observe the healing and consider a boot and early PT. What sort of PT regimen would you recommend beginning at 3 weeks? thx

  15. normofthenorth on March 7th, 2010

    Gunner, nobody’s done fancy studies to find the BEST nonsurgical (or surgical) rehab regimen. I’m following one that’s reasonably quick and “aggressive”, and has been shown (in a fancy study) to produce reasonably good results.

    The details are online at . (If you don’t see the details, click on “Show Detailed Description”.) I linked this from my very first blog at . . ./normofthenorth , and I also linked the results, which were presented at (free subscription required).

    The final regimen (which I’m following, from a printout supplied by the study authors) differs slightly from the one at clinicaltrials, in several ways. I THINK that the one I’ve got is the one they ACTUALLY used in the study. Here are some details:

    1) Instead of “WBAT” (WB as tolerated) from 7-10 days until 6 weeks, “my” protocol says NWB for 0-2 wks, then “protected WB with crutches” from 2 wks until 4 wks, then WBAT from 4 wks on. (Partial and protected WB are pretty fuzzy concepts in practice, so I’m not sure there’s much difference.)
    2) The online protocol says that the 2cm of heel lifts are removed at 2 wks, but my printout says that happens at 6 wks.
    3) Online: “At six weeks the patients will have their Cast Boots removed”; My printout: 8 weeks “wean off boot” “return to crutches/cane as necessary; then wean off”.

    The PT regime I’ve got seems about the same as the one online:
    2-6 wks “active plantar and dorsi flexion to neutral, inversion/eversion below neutral”.
    6-8 wks: “dorsiflexion stretching, slowly” “graduated resistance exercises (OKC, CKC, functional)” “proprioceptive and gait retraining” “modalities as indicated”(?)
    8-12 wks: “continue to progress ROM, strength, proprioception”
    >12 wks: “continue to progress ROM, strength, proprioception” “rtrain strength, power, endurance” “increase dynamic WB exercise, include plyometric training”(!) “sport-specific retraining”.

    That’s typed from my sheet. You can find the online version online, and let me know if they differ much.

    The study results were presented at AAOS 2009, the American Academy of Orthopaedic Surgeons 2009 Annual Meeting, just over a year ago. But I don’t think they’ve been formally published yet in a journal. If and when they are, the article will presumably have full details about the protocol they actually followed. (”Real” publication may also make it harder for the US ortho estestablishment to ignore the results!)

    So the SHORT ANSWER is that I’d recommend “active plantar and dorsi flexion to neutral, inversion/eversion below neutral” for you, under PT supervision (but with “take home assignments”) starting immediately and lasting until 6 wks, when you progress to the next step, above.

    Some of this is Greek, though your PT should understand it all:
    ACTIVE flexion means without bands or weight or hands or towels or straps, just using your own foot and leg muscles, foot suspended in the air. You’re allowed to point your toes freely, and to lift your toes (”internally”) ONLY up to the neutral position, aka “zero” aka “90 degrees”. And you can rotate your foot around its own axis (clockwise and counter-cl), but only with your toes below the neutral position.

    And after 3 weeks of that, you can gently proceed to more aggressive steps.

    Good luck! It sounds like you’re in the enviable and rare position of being able to take a lot of control over your own regimen! That’s very grown-up, compared to most of us, who go this more-or-less as grumpy children! ;-)

    If you’ve been following my blogs and comments, you know I prefer a hinge-able boot to a fixed one, mostly because letting the boot hinge (but not past neutral) is a great (safe and comfy) way to make the scary transition to 2 shoes, aka “wean off boot”. (I think going back to crutches at that stage is psychologically toxic, as well as hazardous to your foot AND the rest of your body!)

  16. gunner on March 14th, 2010

    Norm: sorry for the delay in responding. have been out of town for the first time! this is super helpful. i will do everything i can to get on this protocol tomorrow or soon thereafter if i have to locate the proper boot. will keep you posted.

  17. normofthenorth on March 14th, 2010

    Gunner, since I posted that comment, I’ve also posted (on my own blog page) an OCR’d copy of the exact protocol I was given.

    I’m planning on getting to the bottom of the difference between the two versions — like which one did the big study actually use, or did they shift during the multi-year study? My surgeon didn’t know there were two versions out there; he called one of the nurses who was involved, and she faxed him the one he gave me. And he was nervous (as am I) about the online protocol’s plan to remove the heel lifts at 2 weeks.

    For now, the OCR version I posted should be a good rehab plan, either for non-surgical patients like us or for post-op patients.

  18. gunner on March 15th, 2010

    Hi Norm: Thanks. I emailed info on both boots (donjoy and vaco cast) to my friend the doc yesterday. To my suprise, when I just called the PT to ask about the boots, the PT said the doc had just stopped by, given him a a print outof my email and asked him to see if he could find them. Sounds like he’s coming around. He went to the AAOS convention last week in New Orleans and promised to dosome checking. This is the same convention where the study was presented by the canadians last year.
    It sounds like you are a proponent of the Vaco Cast, if you had to choose. Hopefully, I’ll be in one or the other in a few days.
    I’m already at 3 weeks plus, so removing the lifts at 2 is not a concern.
    You’re 65 and playing professional volleyball?
    best, gunner

  19. gunner on March 15th, 2010

    Norm: Just got back from the doc’s. He took the cast off, did the thompson test and gap test and found no evidence of a “take” on the healing. As expected, I guess, he found no proponents of early ROM therapy at the AAOS conference last week. In fact he cited a recent protocol released by the AAOS which presribes 6-8 weeks of casting for non surgical repairs. It’s on their site under clinical guidelines, dated 12/09. He thinks I am way out there on the leading edge and he may be right, at least in the states. However, he agreed to give it a go, called in the PT, ordered both a Vaco Cast and an air boot to try out on Thursday. Put another cast on till then. The biggest reservation seems to be the risk of reinjury when the boot is off, which I understand. Need to be extra careful, of course. Will update you on Thu or Fri when I get the boot.
    BTW, I have tried a couple times to set up a blog but the promised email with a password never appears. Maybe this time.

  20. RB on February 4th, 2012

    To everybody: just a question, i’ from malaysia and we do not have boots or two shoes or air boots. i’m also following a non-op approach and insisted it with my doctor here though he wanted me to go under surgery.
    I was in fiber cast for 6 wks then another 2 wks of nwb. I’m on my week 10 after the cast and I’m using my normal sneakers with ortho heel lift in walking. I’ve called my doctor and he said i canwalk without support now and can go to pyhsio anytime. It’s confusing though in your countries you have to use diff kind of cast or boots or shoes.
    Well i can walk but limping and have a lot of swelling after much walking but i’m really hopeful that i will get the same result as all f you had or having.

  21. RB on February 4th, 2012

    To everybody: just a question, i’ from malaysia and we do not have boots or two shoes or air boots. i’m also following a non-op approach and insisted it with my doctor here though he wanted me to go under surgery.
    I was in fiber cast for 6 wks then another 2 wks of nwb. I’m on my week 10 after the cast and I’m using my normal sneakers with ortho heel lift in walking. I’ve called my doctor and he said i canwalk without support now and can go to pyhsio anytime. It’s confusing though in your countries you have to use diff kind of cast or boots or shoes.
    Well i can walk but limping and have a lot of swelling after much walking but i’m really hopeful that i will get the same result as all of you had or having.

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