Hello everyone - 4.5 weeks post ATR

Hi everyone,

This is my first post and I would like to start by saying how helpful this site has already been for me. I have asked for my own blog as there are a couple of questions I can’t seem to find answers to my questions for. Firstly I will give you a brief background on my ATR…

I suffered a full rupture playing football on Saturday 17th October 2015, I’m 27. I chose the non-operative route, mainly because I am petrified of surgery and needles, and have a strong dislike for hospitals generally.

Fortunately I went straight to A&E and was in an equinus cast within 6 hours of rupture, and when I saw the consultant two days later he was content that the gap in the tendon was not too large, the tendon was well aligned, and I would generally be considered good for non-operative treatment (thank god).

I was in equinus cast for 3 three weeks (NWB), I am now in an Ottobock Airwalker boot and am PWB. From the 3 week stage - when put into the boot - I was told to start with very light weight bearing and gradually increase this in order to be FWB over the next 2 weeks (so I’d be FWB at the end of 5 weeks). At the 6 week mark I am going to go back and have one of the wedges taken out, at the 9 week stage I will have the other wedge out or be in two normal shoes (I guess).

My primary concern now is the fact that when reading everyone else’s blogs, they appear to have a boot with numerous wedges (say 4 or 5), and they are incrementally reduced, say one wedge per week.

My boot came with only 2 wedges, both being about 1.5 inches tall, so I currently have a 3 inch wedge in the heel. My concern is that when I return to have the first wedge taken out it will be too much of a step down. I have also been on the Ottobock website and there are two sets of wedges available for my boot: one set is the set I have which is formed of 2 wedges, and the second set is comprised of 4 wedges. I can’t understand why in my situation it would be beneficial to go with 2 big steps down in the heel wedges, as opposed to the more incremental 4 steps. What are people’s thoughts on this? I am tempted to buy the other set of wedges myself and take them to my next appointment and say I want to use them instead.

My second query is to do with what feels like tight skin on the bottom of my heel. As you know I am at the start of my 5th week, attempting to get to FWB. Now I am putting more weight on it, I am getting a strange sensation when walking, as though the skin on the base of my heel is stretching (in the direction of the length of the foot). Would this be considered normal? I am encouraged as it is coming from the base of the heel as opposed to the Achilles area, and whilst walking with increasing weight bearing I am not feeling any pain whatsoever from the Achilles or any of the leg area in fact.

My final query is to do with when you should start ROM exercises. I believe that the NHS are currently planning for this to start at the end of week 9, when I come out of the Airwalker. It would appear people on here are starting these exercises earlier. Do you think I should push for this sooner?

Thanks in advance everyone!

10 Responses to “Hello everyone - 4.5 weeks post ATR”

  1. Hi Joep,

    Regarding the wedges, I have read of people doing fairly large jumps as they move to 0, so I don’t think your recovery will be harmed by making a 1.5 inch adjustment. But personally I feel like you do about it, that I’d prefer to decrease slowly and let things stretch out gently. I actually changed my whole boot and got a Vacoped so I could make 5 degree changes and it worked for me. So I think your plan to get the 4 wedges and then ask at your next appointment if you can use them instead is a good one. Anything that makes you feel more comfortable is a good thing.

    Regarding the ROM exercises. I personally think that 9 weeks is too long to wait to start moving your ankle around. By 6 weeks your body has laid all the collagen down to form the tendon and then it starts to remodel that collagen. I think you want to be adding a bit of mobility during this phase, and there are good results with this. I started as soon as I was in the boot. I made sure never to pull my foot towards me (dorsiflex) further than it was positioned in the boot, but I pushed it away from me, side to side and circles in both directions, and I did the alphabet. I had surgery, but Evan’s blog is excellent and he did not have surgery. He has videos of all the exercises he did at all the different stages, and he is doing really well in his recovery (20+ weeks I think now). His blog is http://achillesblog.com/ejbvmi/ and 1-4 videos are:
    https://www.youtube.com/watch?v=Bw6wktBPuPQ
    https://www.youtube.com/watch?v=pEJp0UoT7SE
    https://www.youtube.com/watch?v=_6AIX7nppWM
    https://www.youtube.com/watch?v=rUaLCe1xIfc

    At your stage, check-out video 2 (2nd in the list). Before you do anything, maybe check it with your doctor first just to be sure it’s ok and not putting your injury at risk.

  2. Thanks Beanie - it’s always great to hear other people’s experiences and protocols they followed, especially when there’s been a good outcome. I will watch Evan’s videos over the weekend and I’m sure they’ll be very beneficial.

    Another query for you - when wearing the boot did you wear a sock or anything similar, or were you just bearing skin beneath? I was wearing nothing beneath the boot as the NHS didn’t advise me to, but it led to some pretty bad odour after a fortnight! I purchased a tubular elastic bandage and now wear this below the boot (I also wiped the boot liner with some anti-bac wipes!). Just wondered what most people do in this situation. I think the elastic bandage provides further support.

  3. Yeah, that’s another reason I got the Vacoped. It has changeable liners and you get two with the boot, so you can wash one while you wear the other. For the short while I wore the other boot, I covered my wound with a plaster and wore really loose wide socks. I’ve read that some people wear compression socks to help with swelling. Maybe some others will comment on what they wore to help keep the boot clean.

  4. As Beanie said. Active ROM which uses your own muscles and nothing like a towel or theraband is OK after 3 weeks but make sure your leg is supported. This will help you later. The pain in the heel is something many people speak of and I would not worry. I think a more gradual adjustment would of wedges would do you better and may be less painful based on the many accounts I have read and my personal experience.

  5. Thanks Stuart, I think I will purchase the other wedges and also a second liner.

    I have just watched Evan’s second video and am left very concerned! With regard to walking in the boot, he places the heel of the boot down, rolls forward so the sole is flat on the floor, but then says do not roll forward past that point, up on to the front of the boot, as this would engage the achilles/calf - I have been doing that ever since I got the boot!! :O Can anyone verify whether he is correct or whether it’s ok to roll forward onto the “toes” of the boot?

    And the pain in the heel is holding me back from becoming full weight bearing. I am probably 80% WB at the moment, but don’t want to make that final leap of faith and go 100% due to the heel pain

  6. PS, just complete my first lot of ROM exercises! only moved the foot left and right and curled the foot/toes downwards, but feels good to begin exercising the area!

  7. Joep - The boot is there to stop you from flexing your foot too far and putting too much strain on the tendon in the early stages however indications are that early weight bearing for non op patients is important and engaging the tendon in this way does not endanger the healing tendon. What I am saying is weight bearing engages the tendon anyway. If it hurts then do not do it but since you having been doing this and it does not hurt then you are not causing any damage. Writing the alphabet is what most people are told to do for Active ROM. You should be fine with that. It is nice to get out of the boot but do not be tempted to take those steps just yet. Soon.

  8. Stuart I have not seen your blog and have searched
    Sorry not up with your progress but hope all going really well

  9. Robyn - My page is Xplora but I prefer not to log on to comment. I am one of the old farts around here. I visit regularly but comment less as I feel it is more important for those going through the battle to help each other where they can. My recovery was over years ago so now I tend to comment only when I feel I can offer something different.

  10. Hello Stuart
    Well I’m glad you commented on Joe’s as it was so timely for me to read
    as I had just experienced a pop and weird sensation, intuitively felt it was okay
    but there is always that little voice in your head that questions ” Is it really okay” All those little happenings that are part of the healing process that aren’t mentioned by the medical team. This site has been a godsend and certainly promotes ease of mind and moral support. We’re in it together.
    Certainly has reassured me and kept my spirits high
    Thank you for still taking the time. Very much appreciated.

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