PWB and ahead of schedule!
It’s been six weeks since I had surgery on my ruptured left AT. This Monday, I went to the surgeon to have my second cast removed and am now in a boot and PWB. What a great feeling!
The surgeon was impressed with my ROM as well as lack of severe calf atrophy. Yes, it’s atrophied but not a toothpick. My plantar flexion and dorsiflexion are almost identical to my other ankle and I have no pain or stiffness. The surgeon told me that I am ahead of where most of his patients are at this point and he was very encouraging. He did, however, tell not to use this information as an excuse to go do something stupid that could cause a set back.
I think I was able to maintain flexibility because I constantly moved my foot and ankle while I was in both casts. I wiggled my toes all lot and rotated my leg and ankle left and right as much as possible. I think the most important thing was the fact that for the past four weeks, I have been doing isometric exercises inside the cast by pushing down with my toes and pushing up with my toes. It seemed to help not only the calf but also all of the muscles in my ankle and foot. I didn’t push super hard but I did each exercise at least 50 times every day.
I showed the surgeon Norm’s rehab protocol (thanks Norm) and he said it looks excellent and he had no problem with me following it. He also told me that I could wear running shoes in the house with heel lifts if I wanted and felt up to it but always wear the boot outside for now. I’m reluctant to try shoes now because I’m concerned about re-injury. It’s still good news and I’ll re-evaluate when I’m feeling more confident. I want to be aggressive in my rehab but I also need to use my head.
All in all, a great week.
Keep Healing!
July 21st, 2010 at 7:15 pm
Do you know what angle your foot is at in the boot? And your boot is fixed, not hinged?
I think it’s probably good to go to PWB and even FWB before you go all the way to the neutral position, but you’re far enough along for all of that according to the UWO Protocol. On the other hand, you haven’t been going that fast ’til now, so rushing to catch up (so soon) might be a mistake.
The only real differences between a boot and a shoe with equal heel-lift ankle angle, are (1) physical protection against being kicked and such, (2) impossibility of twisting your ankle sideways (and your foot is still weak and unstable that way), and (3) complete protection against dorsiflexing. If you’re very careful and in a safe and controlled environment and Watching Your Step, there isn’t a lot of difference.
Balancing on your “bad” foot in a super-safe spot (like a doorway) is a great way to start getting some balance and stability and “proprioception” back into your healing foot.
July 21st, 2010 at 8:31 pm
Hi Norm, My boot is a fixed boot and the surgeon told me that with two 1 cm heal lifts, I’m at 10 degrees. I definitely agree that I should be FWB before I go to the neutral position. According the the surgeon, I should remove one lift in a week and then go to to neutral the next week. I am behind the OWO protocol right now because of six weeks in cast so I will heed your advice and not try to “catch up.” I plan to very gradually get in step with the protocol timeline. Balancing on one foot in a safe spot is great advice. Do you recommend doing this right away or when I am at neutral?
I’ll keep posting to update my progress.
Thank you for your enthusiasm and leadership on this site. I think it’s a great help to all of us, as is everyone’s input and support. ATR is a drag but this online community has been a great source of information and inspiration for me.
Keep healing!
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July 22nd, 2010 at 1:26 pm
This is definitely a great site. I don’t know how we can tell the difference between “leadership” and “addiction”, but I obviously can’t stay away long!
(Maybe it’s time for a not-so-Physio therapist!)
You obviously can’t do that 1-foot balancing until you’re FWB, and maybe even a few days’ stronger than just barely FWB. Even with your hands on the sides of a doorway (or a hair’s-breadth away), there’s some risk you’ll lose your balance forwards a few degrees before you catch yourself. That’s obviously the scary direction for your AT. Use your judgment. Cautious, sensible impatience is about right!
If you’re now kneeling when you (e.g.) brush your teeth, you might be able to switch to shifting your weight from one foot to the other. Opportunities for rehab are everywhere when you look around!