6 weeks post-op - Two shoes

Had my 6 week post-op check up with the surgeon this morning, and progress has continued to be good. He started by checking the tendon and the scar, and was happy with both, the tendon is clearly continuously there as it should be, with no significant bumps etc. Scar has also continued to heal well, so no issues there, got some instructions on rubbing the scar in a certain way, in order to maintain movement between the tendon and the skin and prevent scar tissue build up. Generally the swelling around the area is according to him as expected, but actually fairly limited.

Moved on to checking ROM, which he thought was very good for six weeks (I have only a very slight difference on the dorsiflexion compared to the healthy foot at this point, barely noticeable). Finally he had me test a couple of two foot heel raises, which I managed fairly ok, although the strength in the injured foot is clearly somewhat pathetic. Calf atrophy is clear, but he said that he has seen much worse as well. In the end he cleared me to move to two shoes from the boot. I’m meant to walk with a “normal” gait, and roll the foot to the toes as normal, but just leave out the final push from the injured foot for the first week or so, depending on how comfortable I feel. In addition, I was cleared to start some other activities (swimming, stationary bike, squatting with minimal weight, etc), basically the instruction was to not do anything that causes pain, but otherwise fairly liberal. He was also very clear in pointing out that although my progress has been good so far, that as I now don’t have a constant reminder of the boot on, to be careful and bear in mind that it’s still early on in a long process. The expectation now is that if there are no setbacks and progress continues to be good, at 12 weeks I should be able to start running on a treadmill and incorporate some heavy resistance work for the calf to properly recover strength, which sounds very positive to me.

Also had a brief discussion with him about the differing protocols for treatment. He basically said that he prefers the fairly quick transfer from cast to FWB and from boot to two shoes primarily as he believes that (in addition to the easier life for the patient), it obviously helps reduce the muscle atrophy and losing strength in the leg. This in his view helps recover quicker to normal activity, as after the initial 10-12 week period it is the lack of strength rather than the tendon itself that is the main challenge, and as much as that can be avoided early on, the easier the recovery. For him the only benefit of longer periods in cast / boot is to protect the patient from themselves (i.e. not being careful enough).

I’ve now been walking in shoes during the day, and it is actually going pretty well. Clearly my stride isn’t really normal, but I am able to roll through the injured foot without any pain or without feeling like it is stretching the tendon. Walking is still slower than it was with the boot though, but it’s not crawling at a snails pace, hopefully as I get more comfortable and start getting used to this, I will be able to get back to normal walking fairly soon. Will during the first week at least use the boot though in higher risk environments, like when heading out for a few beers tonight to celebrate my freedom from the boot (while wearing the boot) :)

4 Comments so far

  1. normofthenorth on December 5th, 2014

    Sounds great! And the logic is mostly reinforced by evidence, too (which is unusual, unfortunately!).
    One relationship that’s so logical it’s obvious has never been tested AFAIK: that longer immobilization increases atrophy and either prolongs strength recovery or creates permanent deficits, in strength or muscle size. It’s likely true, but it’s a logical assumption in an area where almost every other logical assumption has been proven false! And calf atrophy happens incredibly fast, so even fast-trackers like you get almost a full dose. And everybody says that the calf muscles are among the most resistant to development (maybe especially in size).

    Meanwhile, don’t be too frustrated if that “week or so” to get a normal push-off stretches on a bit. Doug53 labeled this stage The Frustrating Plateau, and many of us have repeated that phrase.

  2. gravity on December 5th, 2014

    Norm, if not studied, it certainly sounds logical. It can obviously be that the atrophy is heavily front-weighted, but even if there wouldn’t be a lot of additional atrophy from a longer immobilization, starting to recover from it sooner should be beneficial.

    Also, the one week period was more a time I’m not really supposed to try and push off the foot, actually being able to do it properly might take longer for sure…

  3. donna on December 6th, 2014

    Thanks for the post. The description of what was done in your 6 week post op was helpful as that is my next step. I was rather disappointed at the 3 week when he didn’t really do anything physically but look at the incision. Now I know what I might expect at 6 weeks in terms of really looking at where I am physically.I’ll ask about how to prevent scar tissue build up as I had forgotten all about that. YAY!

  4. herewegoagain on December 6th, 2014

    Your OS sounds like a great guy- could we clone him?

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