7 Weeks 2 Days Cast Finally OFF

Had my cast finally cut off today. My OS is taking the very conservative path. After cast was cut off and he examined my leg he stated ‘No more cast and you will require PT’
Good as I am itching to get to PT and to recovery. I asked him what do I put on my leg for now. He said ‘Your shoe’
I didn’t even bring my shoe thinking I would be wearing a boot of some type. There is no way I could put my foot down after >7 weeks in a cast. And I am supposed to just walk out of the hospital?

He stated ‘it will be tight as hell’ and ‘I want you to push the envelope but slowly, no sudden stretch’ and then he left the room.

I was stunned, not the way I thought this would go. I have an experienced PT ready to start when the cast came off but I never knew when that would happen and now I can’t get into him for 7 days. OS is correct, my leg is as tight as hell. I am not sure how much stretching I should be doing. I can’t get into the PT for 7 days because he books up so quickly. I am going to try and scramble to find a PT with an opening until I can get to my appt with my PT.

This doesn’t seem like a good situation, it seems kind of wrong. I have no experience on how much stretch or weight I should be applying.

Has anyone else had this type of experience or is this the way it is. Doesn’t seen right to me or my wife.

14 Responses to “7 Weeks 2 Days Cast Finally OFF”

  1. KJJET - I had surgery and was in a splint for 5 weeks NWB because of a tear at the heel. At Week 4, my doctor provided simple ROM exercises to start to get my foot to 90 degrees DF for a boot brace. At the time, my ankle was very stiff. If you cannot find a PT immediately, you can try to do the following. Three times a day perform simple clockwise or counterclockwise circles of your foot. No use of hands or band unless you are under care of a physical therapist. You can try to flex your foot DF (gently flex your toes towards your ankle, no use of hands or band). At first, you will not be able to do much movement, but it gets better. I was able to get to 90 degree DF after 1.5 weeks on my own. A PT will be able to help you with joint mobilization. Good luck and I hope you get the care you need soon.

  2. I’m amazed at the range of protocols and options that have been prescribed……and the casualness with which they are done by the OS……….not sure I understand it, but am getting to the conclusion that between week 3 - 10 is where the discrepancies lie and at week 10 it may not matter what path you took. Just an anecdotal observation. I am at about 6.5 weeks post op and I have been asked to be in a boot since week 2 until week 8, no PT, worked myself to FWB since about week 5.5. Upon calling my doc’s office, about some random pain, the PA suggested that I do unassisted DF and PF, 2-3 times a day but he stressed that I do no sideway movements around the ankle. My initial attempts at DF were pretty poor….could hardly make it to passed neutral (20 deg) and saw minimal calf movement….has steadily been improving and can get to 90deg now and can also feel the calf getting activated…..so may be this where you may want to start hope it helps.

  3. Hello,

    I agree with you and your wife that it does not sound right. I was in a cast for a very long time as well. While it might have been “clinically ok” to go straight to shoes, it would have been very difficult for me.

    When I was switched from one cast to another and started weight bearing, I was timid in the surgeon’s office. The nurse was rather callous and said “you can walk now, go ahead”. So, I have lots of empathy for you.

    As you will see in my blog, I am on a “slow roll” with my recovery. When I went to new stages, I took my time and made incremental changes. Do not be shy about continuing to use your crutches for a while until you have some PT. I found that using crutches and slowly adding pressure to be very effective.

    Best wishes for you.

  4. I’m 3.5 post op and started minor pt this past week. The best exercise I’ve done is ankle pumps. Basically ” pumping” your ankle up and down. In the first week of PT, I am about 10 degrees from 90 degrees. When I first started at the beginning of the week, I was 19 away from 90. So progress has been good and I expect to be at 90 this upcoming week. Doc doesn’t want me going past 90 for a few weeks though.

    Not going into a boot seems odd to me. I’ve been in mine for close to two weeks with PWB and it has helped me quite a bit. May be time for a second opinion…

  5. I’m 6 weeks post op (2 weeks minor re-tear that hasn’t pushed us back at all luckily) I’ve been in a boot since 2 weeks post op starting at 30 then going to 15 and within the next week zero to shoes/heel wedges.

    I know there are spirited debates on different protocols here, non-op/op/early wb/aggressive pt, etc but the boot seems like a common thread throughout all options.

    How experienced is this surgeon in Achilles injuries and recoveries? Is he a foot and ankle specialist? Seems quite odd I’d go for a second opinion prior to getting into shoes..heck I’d buy my own boot in the meantime, I can’t imagine going to shoes (did he even advocate heel wedges?) right after casting (esp for 7 weeks)

    No sudden stretching? Going right into a shoe is going to increase the chance of that exponentially, that’s exactly what a boot prevents in most cases.

    Odd advice, might be time for round 2 on opinions.

  6. Kjjet, my advice is still to try to follow the evidence. Your doc seems to be an outlier. Following an outlier rehab post-op doesn’t seem to change outcomes very much, even in large studies, but following an outlier rehab non-op definitely changes the odds of success vs. failure. As I wrote to you before, the good news is that many patients succeed pretty well non-op even with weird rehabs that produce too many failures (reruptures). But a bad rehab non-op clearly makes it more likely you won’t be one of the lucky ones. The good rehabs would have been much faster for you in weeks 2-7, and wouldn’t put you in 2 shoes until week 8, after 4 weeks of FWB in a boot. If you’re super careful and super incremental in shoes now - and a bit lucky - you may come out fine. If you can hook up with a doctor or a PT who’s read the evidence, your odds may improve.
    It’d be great if there were a way to weed out Doctors who just make stuff up. Malpractice suits probably help do that in litigious societies like the US, but even Americans don’t seem to sue much over lousy ATR care, and Canadians sue less in general. So the Doctors just keep doing what they do, and they get lots of money and respect for doing it, right, wrong, smart, stupid, open to new ideas and evidence of closed. God bless the good ones!

  7. I hope you are doing okay. I see you posted this over a week ago. I was out of my cast in 2 weeks, into a boot full weight bearing, then into shoes at 6 wks. The fact you were in a cast so long is strange to me. I’m no professional but I did have one of THE top OS in our region do my surgery. With the different protocol seen here on the blog, one thing is consistent: everyone transitions to shoes through a boot. If you haven’t sorted it out, I’d get a second opinion. You could seriously re-injure yourself without proper support before you are ready.

  8. Thanks for all the advice everyone. The way my OS has treated this injury doesn’t seem to follow any others that I have seen on this site. And I am not too impressed. Went to my first PT Thursday, he is very experienced in ATR recovery. He was surprised with the OS response to put on a shoe and walk out of the hospital. He took all of the necessary measurements and we are starting PT.
    I had a slip this week, it was nothing more than getting off the couch wrong. The pain was immediate and intense. I don’t know if I am being a wimp or what but there is no way I can walk on my leg. I thought I had re-torn the tendon again. I had been performing ROM exercise all week and was able to move my foot to 90 with no pain. I was able to put full weight. Thought I was on my way. Then I slipped and lost 80% of the movement I had gained and my ankle swell back up.

    PT was surprised at the loss of size and definition of my calf, as was I. But I haven’t used it in 9 weeks so I guess its to be expected. He says it should return quickly. He said that I should see good results in the next 2 weeks. I told him about the slip and he said that the pain was good that means that there was healing. If there was no pain that would be bad news. The pain doesn’t feel like good news but if that’s the way it is to be so be it.

    Next week 3 days of PT, I really need to get back to driving. I am feeling like a prisoner always having to rely on people for rides. Frustration is setting in.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  9. Slips can be quite dangerous at this stage of healing. If the movement and strength you had does not return in the next 2 weeks then I would advise more investigation. For now you can rub your thumb and index finger up and down the tendon. Use a bit of cream to reduce friction and feel for any gaps. After what you have described I would also suggest speaking to the Doc to see what he thinks. I am not trying to alarm you but feel it is better to be thorough. If your PT really knows his/her stuff then they should be able to check for a re-rupture but normally people go back for an MRI after a slip with notable pain and significant loss of function. I hope it is all good for you.

  10. So I had a partial re-tear at 4 weeks post op bc I fell off my scooter.

    If you didn’t feel a pop or a tear or hear either then that’s a good sign, if the wound didn’t bleed that’s also a good sign.

    I experience a pop sensation, a partial gap when touching it, and some bleeding.

    We couldn’t tell the extent of it on the MRI b/c of the previous surgical trauma and the DR was very apprehensive about just putting me back on the table “just to see” (healthy 34 yr old) and said he would back a non-surgical route fully.

    That was a hard call for me. So far it seems to have been a good decision. I don’t get into right and wrong in hindsignt, you can only make a decision based on the evidence and info available (and your own personal factors.

    Have you gone back to the OS after this mishap? Perhaps an MRI is in order?

    Did the PT do the thomson test? what did that reveal?

    Good luck, I know the feeling.

  11. Sorry to hear about your re-tear. It happens so fast and there is no backing out. What is done is done. It makes you realize how fragile the tendon still is until it is healed.

    I had no pop or tear (mine was non op). PT performed the Thompson test and it was ok. There is swelling of the tendon and I have been doing ROM exercises all weekend and the rotation is coming back but with moderate pain. I do think your pain threshold changes during this ordeal, I think what would have been a 5/10 pain level before would now be a 2.

    I haven’t gone back to the OS or my doctor as I still had control of my foot. It was just sore. As this was a Non Op recovery the most they would have done is put my back in a cast. I have a boot now and have been using that with and without crutches.

    One thing that is constant on this blog is that you can’t rush it. It takes time and I guess I am running out of patience with myself. I need to step back, regroup and follow PT orders. It is frustrating for me to watch my snow machines taking off without me. I can see the ski hill from my house and all I am doing is sitting here looking at it, arrg.

  12. I went non-op on the re-tear, my tendon doesn’t really swell much ankle does a bit. No pain either, DF to 5 and 0 pretty easy, theraband exercises produce no pain. I was expecting more advice from my OS but it seems clear that its the PT and I now, so just trying to get in that mindset.

    I hear you on the frustration, I’m at the 8 week post op mark and even with the re-tear the PT has me on track as if there was no 4 week re-tear so I’m itching to ditch the crutches.

    I am a bit concerned about his plan to FWB for about a week at zero and then into shoes if I tolerate that well, seems quick but I trust him and he’s a pro so I’ll roll with it. Maybe I should pay more attention to how it feels than (some) arbitrary protocols that might have a 1-2 week difference (mass general’s vs ohio state for example)

  13. Kjjet - this is good to hear. Slips, misteps and falls are dangerous but don’t confuse that with sitting around doing nothing until your tendon heals. Your tendon does need that incremental loading to become strong again. The collagen fibres need to align in the direction of force. The initial collagen that forms is weak and disorganised and it is replaced by the good stuff as you start working it. Trust your health professionals as they seem to know their stuff. Not all do though and I have seen some weird treatments come through these pages. We all understand the feeling of sitting around. It seems like a long time but in fact it is the shortest part of this recovery.

  14. I hate the whole cast thing. I ruptured my Left AT about 7 years ago and was in a boot post-op. I was out of the boot in 4 weeks and in two shoes. From there I didn’t do PT and my achilles is stronger then ever. With that said, I just ruptured the Right AT last Saturday. I already had surgery and currently sitting on my couch in a boot. I fully expect to be FWB and in shoes in 4 weeks.

    My surgeon is aggressive with treatments if you are a fit individual. If it is like my last time, I expect to begin some range of motion exercises after my follow up in 10 days.

    One thing surgeon said last time was to follow your gut and listen to your body. If you feel nervous maybe you should try and find a boot on craigslist or just buy one outright from a medical supply store. With that said, after seven weeks you should have a repaired tendon. I realize everyone is different, but I expect to be walking in 4. I hate the cast because it limits you from stretching the tendon before you are thrown into the deep end of the pool.

    I would try to assume that it is repaired and begin working and stretching though range of motion exercises. However, I’m just a guy on a blog, and maybe your best move would be to call another specialist and relay your situation. Another specialist may alleviate our fears or put you on a different/safer path to recovery. Good luck and the good news is you are almost out of the woods.

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