8 weeks visit


Written on August 18, 2010 – 3:33 pm | by firstdayofsummer

So I went to see my OS for my 8 week check-up this morning and again was quite surprised by him!

If you recall, according to him I should still be in a cast at this time, yet at my last visit 3 weeks ago he told me to go FWB. Today he examined my tendon and told me to wean myself off the boot. I have been following the non-surgical protocol as provided by Norm, see details here:

http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/

That is, I have been following the protocol except for the early PT with a therapist since my OS would not give me a go ahead for it yet. He also pretended not to be aware of me following the protocol for the first 5-6 weeks (meaning he  did not want to hear about it).

So today I am telling him that I’m not sure I’m ready for 2 shoes yet and his response was (Norm, you gonna love this one) ‘just continue following your protocol! You are doing great and are 4 weeks ahead of schedule so continue following it, that is wean yourself off the boot now’  Once again I was speachless!

Also, he told me to start driving again, ‘as soon as you want to’. Well thank you Sir but no thank you! My tendon is still very, very stiff and it’s the right tendon, so unless I’ve had a few sessions of PT I don’t think that’s in the interest of the public for me to drive around.

I am very excited to start my PT this week (both hydrotherapy and PT)….any tips as to which exercises to approach with caution at the beginning?

Oh and for anybody who ruptured around the same time….do not listen to the ‘4 weeks ahead of schedule’ stuff! Honestly I don’t even know what doctors base their timeline on, other then in my case the fact that he originally wanted to keep me in a cast for ‘at least 8 weeks’. According to Norm’s protocol on the other hand I am 6 weeks behind on my professional PT so I think we should just all listen to our tendons and do what feels right for us…..if it takes a couple of weeks longer so be it, rather safe then sorry is my mantra right now ;)

Happy healing everybody.

  1. 17 Responses to “8 weeks visit”

  2. By normofthenorth on Aug 18, 2010 | Reply

    I DO love the fact that your doc is now such a convert to the UWO protocol! (Now if those bums would just actually publish their study!)

    Weaning off the boot is probably the scariest step of all — depending on how well you handle stairs on crutches! ;-) . And the fear is justified, because you’re WAY more likely to do serious damage when you’re out of the boot, even though your AT is getting stronger. 12 weeks in is the average rule-of-thumb for when the (vast?) majority of re-ruptures have already happened.

    But you’re allowed to do it at your own pace, using common-sense and fear to guide you. I padded around the house in Crocs right at 8 wks, but I put the (hinged) boot back on for scarier activities, like bicycling or walking in crouds. For another couple of weeks, then I put the boot away completely.

    Of course, I’d been doing more exercises and PT out of the boot, so I was probably more comfy with that. Maybe mostly psychology, not physiology.

    The driving thing — where driving in a boot is legal — is both personal and controversial. My second ATR was easy, with a left boot and an automatic car. First time, with a right ATR and a shift car, I think I did some driving in the walking cast and then in the boot. Some cars have tighter spacing between the pedals, or other obstructions that make it unusually scary.

    Driving when your right ATR is freshly into “2 shoes” is also scary, for your AT and for others. During that time — and when I was driving between my first ATR and surgery (9 days later), I just learned to stomp onto the pedals with my heel, not the ball of my foot. It’s harder to drive really smoothly (less fine motor control), but I personally never felt I was a high risk on the road.

    One of the main benefits of getting out of the boot is that you start re-training your foot and leg to do all the OTHER things they’ve got to do, like the “proprioception” feedback and control that makes it possible to balance well. You can do some of that in the boot, but it’s way more intense in a shoe or barefoot.

    At my advanced stage (8+ months), I’m still noticing the hairy dance-steps I do several times a day in normal life — rushing around, then changing my mind about which way I’m going, type thing. All things I wouldn’t recommend for you, and wouldn’t have dared do a few months ago.

    Enjoy the transition and the freedom, but Watch Your Step! (Who KNOWS what attitude your Doc will have in the future if — God Forbid! — you blow it!!)

  3. By stephanie on Aug 23, 2010 | Reply

    Hi johanna

    I cant believe your Doctor said you can start driving at 8 weeks. I was told by the doc I can start driving when I can do a emergency stop. I am almost week 14 post atr non surgical, injured my right foot. I have only started driving yesterday. I think I will only drive for short distances at the moment and stay away from the highway as the tendon still feels quite tight. I would say listen to your tendon, if it does not feel right then dont do it. You will feel much better once you start doing physio.

    Good Luck

  4. By firstdayofsummer on Sep 21, 2010 | Reply

    Stephanie, sorry I only saw this now!
    You are right for not driving earlier. Though my OS gave me the go-ahead it just did not feel like a safe thing to do and I first wanted to do a couple of PT sessions. My tendon has improved greatly since the 8 weeks check-up yet only the last 2 days do I feel that it will be okay for me to drive again. So this coming weekend I will go ‘practise’ on a big, empty parking lot. This will make it exactly 14 weeks post ATR so clearly your Doctor has more experience with the non-surgical protocol.
    How are you doing now?
    Happy healing

  5. By GerryR on Sep 21, 2010 | Reply

    Congratulations to both of you for not driving when it was unsafe, not only for you but for others as well. I have been appalled at the attitude of some people that driving is a “right” rather than a privilege. I have mostly refrained from saying anything but nobody has the right to endanger other people. Driving a car with an automatic transmission in the US is OK if the injured foot is the left foot and if the injured foot is the right foot then it would be OK to drive an automatic in countries that use right hand drive cars. Driving a manual transmission is just not safe with a cast or boot on no matter what. And if a person is going to drive then they need to be able to do the emergency stop.

  6. By stephanie on Sep 24, 2010 | Reply

    Hi Johanna

    Good to hear that things are going well for you. Life is getting better and almost back to normal. Although the ankle is still very stiff in the morning, once I’ve warmed up I can walk without a limp. I do wonder if the stiff ankle in the morning will ever go away! My physio is down to every 2 weeks now. Also I have been driving everywhere now, feels great not having to rely on friends and family to drive you about. Good luck with the driving this weekend. You will feel fine driving after a few practices.

  7. By northrancher on Oct 10, 2010 | Reply

    Hi Johanna,

    I’m a newbie–just 8 days post-injury and thanks to Norm’s info & cases like yours, I’ve just decided on the non-surgery route. Tomorrow, I will tell my OS and be on my journey (with his support, hopefully)to recovery. I’m in a walker hinged boot right now & debating whether to switch to the VacoCast. How long did you use that boot and did you ever graduate to a hinged boot?

    Thanks, Grace

  8. By gunner on Oct 11, 2010 | Reply

    north rancher: Glad to hear you went the nonsurgical route. I chose the same path and have no regrets.

    I also chose the VacoCast. I will never forget the experience of putting it on for the first time, after the cast - the comfort, mobility, stability, ease of use, appearance were delghtful. My only regret is not convincing my doc to move from the cast after 2 weeks instead of 3.

    Hope your recovery is speedy and complete.

  9. By firstdayofsummer on Oct 11, 2010 | Reply

    Hi Grace,
    I agree with gunner regarding comfort ecc (and he was one of the driving forces for me to choose the VacoCast). I was wearing the boot for about 6 weeks (like gunner I only started at week 3 because I didn’t expect my OS to give me the go ahead that early and lost a week between ordering and next visit with my OS).
    The VacoCast is a hinged boot, yet I only used the hinged feature (that is I slowly unlocked it and increased the ROM by about 5% each day over a couple of days) at week 7 or 8.
    Good luck with the healing! My tendon feels great and is improving weekly. I started yoga again, am still doing PT, driving myself everywhere and in general am just thrilled with how the non-surgery route worked for me. I would do it again any day (if I absolutely have to ;)

  10. By northrancher on Oct 15, 2010 | Reply

    Johanna, I’m thinking about getting out of the boot I’m in and getting a VacoCast. It’s so uncomfortable and I have a lot of pain at night. How did you know which model VacoCast to get and did they ship fast?

    I’m also curious–since you are so far along and healed so well–what kind of pains did you have in the first weeks? I have a burning sensation in my foot that comes and goes, heel and instep pain and I’m thinking it’s caused by the boot! My calf rarely hurts–just some aching.

    I’m so encouraged by your recuperation–you are one of my role models here!! Keep up the great work on your recovery.

  11. By northrancher on Oct 15, 2010 | Reply

    Gunnar, thanks for the encouraging words. I’m finding the boot I’m in very uncomfortable and I think it’s the cause of other pains. Which VacoCast model did you get?

  12. By titip on Oct 28, 2010 | Reply

    Hi. I severed my tendon on 8/28 and am just so lost as to what to expect moving forward. A friend told me to go online and look for a site where folks blog and ask others questions. I’m so not an internet person, and so it took me forever, but here I am. Am I even posting this correctly…. ? I’m soooo lost. I had surgery on 9/15. Was in a cast for 2 weeks, then for 4 weeks, and just got this huge brace yesterday. I hurt so very much, and even an ounce of weight is painful. It’s always swollen and I can’t really do anything. Is this normal, or am I a big wuss?

  13. By firstdayofsummer on Oct 28, 2010 | Reply

    Hi titip,
    sorry to hear about your pain! As humbling and unpleasant as this whole experience is, it does pass and there are many wonderful people on this blog that happily share their experience with you (I have to admit that normal life has taken over again and I don’t find as much time as I would like to spend on this blog).
    I was lucky as far as not having had any complications but every person is different and there are therefore many that can answer your question. I suggest you post your question to the general link below (which everybody can see).
    http://achillesblog.com/how-did-achillesblogcom-start/

    Since you mentioned your not being that familiar with the internet I take the liberty to copy your question there for you. Just scroll to the bottom to read the responses.
    Good luck and please don’t hesitate to ask me or anybody else any questions.
    Happy healing,
    johanna

  14. By GerryR on Oct 28, 2010 | Reply

    Titip,
    Several questions.
    Has the incision completely closed or is there still drainage?
    Is the area where the swelling is red or hot to the touch?
    Are you elevating, as in above your head, and icing your leg for several hours daily?
    Did you ever do the elevation and icing for several hours daily?
    Are you PWB(partial weight bearing) or FWB(full weight bearing)?

    Pain in the heel is pretty common after several weeks of not bearing any weight on the injured leg. But it usually goes away in a few days. Only you can judge how much pain you are experiencing so you won’t find anyone here that will call you a wuss.

  15. By titip on Oct 28, 2010 | Reply

    Thank you so very much. I really appreciate it.

  16. By titip on Oct 28, 2010 | Reply

    Hi GerryR,

    the incision is completely healed. There is no drainage. The area around the wound seems to be okay. I’m elevating for at least 4 to 5 hours a day and at night all night. I’ve been icing it twice during the day and one ice pack at night. I was no weight bearing until yesterday, where I was told to use my crutches and in small doses try applying weight until I transition off of the crutches. I severed the tendon and tore two minor tendons in the side. Apparently I had tendonitis, and in rushing up the steps I mis-stepped and really hurt myself. I start PT next week 3x per week for both legs. This has been insane. I just have never had anything completely, stop me like this.

  17. By firstdayofsummer on Oct 28, 2010 | Reply

    northrancher,
    I am so sorry for only responding to you now (I never got an email alert for your comment).
    This might be too late to answer your question but I did have a ‘burning pain’ in the first couple of weeks. It mostly felt as if my foot was on fire. And if I say ‘in the first couple of weeks’ I do not mean that the pain was there constantly; it really just happened in waves and I always convinced myself that it was a sign of my tendon healing.
    How are you doing now? Please don’t hesitate to contact me for any questions, I am more then happy to answer (in a more timely manner this time I promise ;)
    Happy healing
    johanna

  18. By GerryR on Oct 29, 2010 | Reply

    titip,
    It’s good that the incision has healed well and that you’re at the PWB stage. I would recommend elevating your foot as much as you can. As it was explained to me by my first surgeon and later by a physical therapist, the foot acts sort of like pump in helping circulate blood around. When you don’t put weight on your foot the blood doesn’t get pumped out as fast so you get swelling. As you put more and more weight on the injured foot and walk around, the swelling will diminish and finally go away entirely. But, it does take time. As for the pain in your foot there are various wooden devices that you can roll under your foot which will help alleviate the pain. Also take 800mg of ibuprofen every 4 hours to help with inflammation. It will also help the pain a bit but mostly the inflammation. You’re covered the hardest bit in this recovery process, getting to PWB. We also know how wretched it is to be active and then suddenly you can’t do anything. I was well on my way to cycling probably 4,000 miles last year when I tore mine on July 27. Then I was on crutches until just before Thanksgiving. There were some pretty dark times but I’m about 85% now and happy to be back cycling and running and preparing for another ski season.

    Now, go to the main page and read the third paragraph a couple of times and then follow the directions exactly to get your own blog set up. There are plenty of us around that can help you with the technical bits of using it. It is really much better to have your own little corner of the world here than to always have to post on someone else’s blog. It really isn’t hard.

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