Posted by: johnsfbay | March 2, 2012

Joined the Club in SF

Hi everyone,

Seems like I know many of you already from my many days of reading posts over the last 5 weeks.  Before starting with my injury, let me thank Dennis for organizing this blog, and all of you out there for sharing your experiences with this injury and its trying rehab.  Having extensive and timely information is really important when you are hurt and wondering first what you have, then what to do about it, and finally how to cope with it.

I am 52 and very fortunately was able to retire about 1.5 years ago.  As a kid, I loved playing soccer but gave it up in high school and never seemed to have the time, nor was in the shape necessary to play during my working years.  One of my goals at retirement was to get back into the game that I loved.  After getting in pretty decent shape via 2 years of gym training and some aerobics classes, I took the plunge.  Needless to say, ballistic movements are a lot different than gym training, so I had a few (several) hamstring pulls that kept me off the field more than on during the first year.  Then in January, after doing some extra training work on my ballistic running, I decided to take an indoor soccer class at the local community college to get my soccer fundamentals back.  It was during that class that the dreaded “coach some kid must have kicked me when I got the ball away from them” happened.  And so on January 25th 2012 I joined “the club”.

Against norm of the north’s best advice (awesome posts by the way norm, and others), I decided to go with the surgical route.  Surgery went well, and the surgeon noted that the tendon ends “looked very good”, so that he felt a strong tendon recovery was possible.  After 11 days in a splint, and 3 NWB casts (1 per week), I was allowed to move to a boot (non-hinged unfortunately) three days ago and moved to PWB.    I am already wanting to move to FWB in the boot - ok, I admit I cheat sometimes and try it every now and then just because it is convenient.  I really haven’t had all that much pain, except for the first day or so after the ATR, but I realize from “Frouchie” that slow and steady wins the race, and several of you others that no pain may not mean progress with this injury, so am trying to be a little conservative in my rehab.  I have a trip planned with my kids and grandkids to Spain for 3 weeks in April, and want to be as mobile as possible while there - if I mess up and relapse the family will disown me!

My surgeon will review my progress in another 4 weeks (ATR plus 9 weeks).  However, he has said that over the next two weeks I can go to FWB, and then wants me to continue FWB in the boot until I see him next.  My biggest question is how do I know when it is time to go FWB?  As I mentioned before, I have no real sharp pains, just some swelling and it isn’t uncomfortable when I try FWB in my boot for short distances in the house.  Should I continue to follow the 2 week PWB protocol as my doctor suggested, or move to FWB sooner because it feels ok?

As for PT, the surgeon gave very little to perform now that I am PWB, and what he gave me seemed a little odd based on reading through some of the extensive PT plans that you all have provided on the site links.  He has me doing ankle flexion-extension with and without a resistance band a few times per day.  After I sent an email asking him about using the stationary bike in the boot, or doing some walking in the pool at my gym (without boot), he emailed back that all FWB should be in the boot until he sees me again.  I believe that allows for the stationary bike in the boot, but not the pool which I can’t do with my current boot (of course the Vacocast would allow that option, or maybe some other brace?) .  Needless to say, after seeing the PT regimens that you all have shared, I have added many of the exercises that are in Dr Berkson’s 4-8 week rehab program link, and may cheat and get in the pool without the boot after I go to FWB.  Seems like many of us ATR patients are given little in the way of PT in the first 8 weeks, so many of us go with our gut, and sound plans from others, and do a little more!

So I just wanted to say hi to everyone, and thanks again in advance for all of the good advice that I’m sure you will provide me along my marathon :)

John

Responses

Hi John,

Per you question above, my experience was to go FWB in boot when it felt right to me… and that worked out great - but I wasn’t given any instruction about it either way. Listening to the docs is of course recommended, but listening to your body is, I think, equally important. For what its worth - even though I went FWB in boot at about 18 days post surgery, it didn’t do a thing for slowing muscle atrophy… Still had no calf muscle once I got out of the thing.

re: the pool–if you are in waist deep water, you are only 50% weightbearing…so, if you can get into & out of the water with no boot (I sat at the edge of the pool, took off my boot & then slipped into the water, reversed the process for getting out) you should be OK to be in the water.

My surgeon’s advice was to get into the pool for swimming & walking (waist deep water or higher) as soon as the scabbing was completely gone from the incision. The first time or two you may want to have a friend or the lifeguard give you a hand managing boot/towel, etc.

Hi John,
First, I am truly sorry you have joined this club.
Hopefully you will recover fully and quickly. It seems to me that healing is a highly individual process, and many factors such as age, health and fitness level prior to injury, your surgeon’s ability and even your support system play a role.
In looking at your timeline, I am surprised you are planning a trip to Spain so soon after your injury.
To explain, I live in L.A and travel to Europe often (business). My doctor told me I would not be able to travel for five months after surgery because there is a high risk for blood clots which a long flight will aggravate. In fact, I am going to Spain on March 17, and that is exactly six months after surgery. Did your surgeon gave you the OK to travel?

re: pablomoses - it is amazing how little time the surgeons have to discuss these things with us, isn’t it. FWB seems to be ok for my foot, but I’ll take it easy for the first few days to be sure. Were you told to sleep in your boot - I’ve been sleeping without for the last couple of nights, but not sure if there are issues I should consider?

re: kathyw: thanks for the pool advice. I’ve been nice to the lifeguards, so I’m sure they will help me out my first few times. I still have the white tape strips over my scar, so can’t tell if the scar scabs are still there, but my doctor is allowing me to shower and get the area wet - I’ll double check with him to be sure.

re: housemusic: Hmmm….I’ve mentioned the trip both of my recent visits to the surgeon, and he didn’t say anything about it except making sure that I get up every hour and walk around. My focus with him had been on being more aggressive on getting to FWB as soon as possible, so that I can be more mobile when in Spain (to visit sites like the Alhambra). I’ll check again and see what additional precautions he recommends. Thanks for the heads up!

I can offer one other datapoint re: blood clots and air travel.

My surgeon gave me the OK for a short (~2 hours) flight, 5 weeks post surgery. I don’t recall his exact words/timing, but recall that he recommended against longer flights for the first couple of months.

Immediately after surgery, I was put on a regimen of low-dose aspirin. I was given the OK to stop that at around 6 weeks- told that the blood clot risk had subsided. I imagine, that’s about the time unrestricted air travel would have been OK’d too.

Being nice to the lifeguards is a very good policy in general :)

On my second visit to the pool with my boot, I noticed a folding chair off to one side & asked the lifeguard if I could use it for re-booting post-swim. After that, every time I came to the pool with my boot, they got it for me before I could even ask….and, a couple weeks later, when another swimmer showed up with a boot, they got the folding chair for her, too.

Good luck, I hope you can get in the water soon! It was a life saver for me…

HI John-
I never slept in the boot… I had a splint and ace bandages from my trip to the emergency room that I put on for a couple of days after getting out of the post-surgery splint… But I slept with bare foot from about week 3 on with no problems.

My sleep experience was similar to Pablomoses. I got out of the post surgical cast around day 5; and went into a splint with Ace bandages. I slept with that splint- but started weaning myself off of it (sleeping) at around 2 weeks. At day 17, I started sleeping bare-foot, and didn’t have any problems.

Doc put me in a boot at day 19; but I never slept in it.

Great, no worries about sleeping without the boot then, thanks pablomoses and ryanb.

And kathyw, I’m going to try the pool tomorrow and get started walking down the lanes. I had been going to aqua aerobics classes prior to my injury which were great, but I need to be able to push off with my injured foot first and jump so I can not do that right away. It will be nice to see my buddies again at the class after missing 7 weeks due to my ATR.

My move to FWB in the boot was very easy and quick after getting my cast off last Tuesday. It feels very normal to walk in the boot, so I think the crutches are gone for at least another 3 weeks until two shoes begins! What a difference not having to use crutches makes!

One last question I had was related to a little numbness in my little toe from time to time, especially when the ankle gets swollen. Is that normal, or could it represent some nerve issues?

Thanks again all for the responses!

I’m also an sfbay area person…Full rupture on Feb 2, now 1 week in boot. The main reason I see for staying in the boot is for the unexpected… Like the recent 4.0 earthquake at 3am, for example?-)
Sure that is extreme but I still feel more comfortable with the boot protection but I’m just starting to test out pwb on my own.. Dr said not until another week when I start PT.

But I should get a vacocast I ordered on my own on Monday and plan on hitting the water. The above is the first i’ve heard of getting in the water without a boot is “ok”.
I too still have times when the foot or toes feel numb.

Peter

First, sorry about the ATR…

I would check with your PT about what you can do with the new boot, and without, in the water, especially as you are just starting PWB. You are fortunate to be getting PT now…I still have to wait 2 more weeks until I move to 2 shoes before I can see a PT.

The ROM exercises my surgeon gave me to perform daily at week 5, plus 2 a week sessions with my trainer at the gym since my ATR, are really helping my left leg and calf to feel stronger. I’ve also been using the spin bike for 30 minutes with my boot on, which really feels good as it is the only aerobic workout I am allowed to do so far.

Good luck swimming with the vacocast - that should be great exercise!

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