I am now 4 weeks (and 45 minutes - 2pm football kick off and lasted 5 minutes) post ATR - conservative management. I started in the vacoped boot 2 weeks ago locked in 30 degrees plantar flexion. The last 2 weeks have been great. Pretty much zero pain and getting around fine on the crutches. I have been back working in the physio clinic seeing patients 3 days a week using a saddle stool and have borrowed an automatic car for getting around. I get a bit of swelling by the end of the day but this is sorted easy with ice and elevation.

Today was my OS appointment which involved the usual 6 second check with one of the junior surgeons. The boot was kept on throughout the appointment and was advised to start adjusting ROM and return in 4 weeks. Physio appointment has been booked for 2 weeks time. I have adjusted the boot to enable 30-15 degrees of plantar flexion. When the boot gets near to 15 degrees of plantar flexion I get quite a lot of tightness in the lower calf / Achilles tendon. I am presuming this is natural and will ease over a few days. I feel I am being more protective with the weight bearing since I adjusted the ROM earlier today. Anything near full weight bearing at 15 degrees is uncomfortable. Has anyone else found this? How long did it take to ease?

Looking at some of the protocols I have seen people advised to sleep without the boot from 4 weeks onwards. Have any of you done this or all left it until later on. The boot isn’t really bothering me at night and I would happily leave it on if needed. However, if it is no longer needed it would be great to sleep without it.


12 Comments so far

  1. ericm on May 13, 2015 4:59 pm

    Hi Kristian,

    I’m not quite there yet but was wondering the same thing. From reading on this site most people leave the boot on for a few more weeks for peace of mind but some begin sleeping without it at around 4 weeks. Some of the decision depends on how much you toss and turn, whether you often get up in the middle of the night, and how clumsy you are, etc.

    I just got my Vacocast yesterday and started PWB. Wow this thing is thick on the sole!

  2. eyceman on May 13, 2015 5:02 pm

    I think I started sleeping without boot at week 6, which was 2 weeks out of my cast.

  3. Kristian on May 13, 2015 5:21 pm

    Hi ericm. The rocker sole is thick. Makes much more sense once you can get to 15 degrees plantar flexion. It makes your foot feel level. I’m using the evenup on the other side which is a help. Could do with being even higher if anything. Tried putting the flat sole on the vacocast earlier. Doesn’t work at 30-15 degrees. Will leave that for another 2 weeks when can go to 0 degrees.

    I’ll make a last minute decision regarding sleeping. Would be good to sleep without it on.

  4. ericm on May 13, 2015 7:29 pm

    I didn’t come across anyone who tried sleeping outside the boot and had significant problems. The downside is the covers tend to make our feet planter flex at night so in the morning you get short/tight/sore when going back in the boot or walking. If you stay in the boot it helps stay stretched but then you don’t get a break from the boot. I was contemplating a night splint to still get some stretch but get some time out of the boot and reduce bulkiness.

    I will probably have to order the evenup because I can’t imagine walking with one leg this much longer than the other.

  5. Stuart on May 13, 2015 10:28 pm

    Kristian - I really couldn’t sleep well with the boot and that was affecting me more so at 3 weeks I took it off at night but it stayed beside my bed and I never tried to walk anywhere without it. When you wake up in the middle of the night and feel the need to go to the toilet it is easy to rationalise how much of a pain it is to put the boot on for a couple of minutes. I often thought about having a brace made for night. You would have access to the plastic and could mould one to 15 degrees max and put some velcro on. Have a look at the further reading tab on my page (Xplora) and there is a picture of what I mean in the first study on early weight bearing.

  6. LindaF on May 14, 2015 2:17 am

    I was sleeping in my boot until week 9 which coincided with the removal of the last wedge and my foot being considered neutral. Just wanted to give you another data pony, though it seems that others were allowed to sleep without the boot sooner.

  7. donna on May 14, 2015 5:40 am

    Never slept in the boot when I got it at 3 weeks post op. used ace bandage to keep foot in same position the boot would have with much more comfort…put foot up on pillow and outside of covers…am a good side sleeper who doesn’t move much. Used a walker when I got up at night to use the restroom.

  8. Kristian on May 14, 2015 8:01 am

    Thanks for the info everyone. I went for no boot. I never get up in the night. No issues. Was nice not having the boot on. Didn’t sleep well but that was the whole psychological side of trying to be careful with the foot. I even had a dream that I got up and walked without remembering the boot. Sure that was a one night thing.

    I was expecting a bit of tightness this morning with the boot on. It was actually much better than yesterday. Able to put more weight through it at the 15 degrees and can get about short distances with 1 crutch for the first time.

    My main concern with the conservative option has been wondering if the tendon is healing and if the Achilles has reattached. With the boot set at 30 for 2 weeks i had no discomfort whatsoever. I know this is a strange thought as I have never heard of anyone’s tendon not attempting to reattach. With surgery you know it is attached unless you hear a snap or pop. Now the boot allows some movement I can definitely feel a stretch in my Achilles and a mild ache in the calf with prolonged walking. I’m taking this as a good sign and that they are working to some small degree :)

  9. Tomas on May 20, 2015 2:42 pm

    Hi everyone. Just found this blog! I had full rupture almost 4 weeks ago (22th of April), after this I had a plastic cast for 3 weeks, and now one week have boot with adjustable angle. It is already second day as I’m walking at home without crutches… I mean, I can put all my weight on operated leg. Can I do this? Is not too early? I don’t feel any pain doing it and tension is almost minimal. My boot’s angle is near zero degrees (even doctor looked surprised seeing it). I already started to sleep without boot… Is everything “according to plan”? I read, that a lot of others are starting with 30 degrees on they boot, putting 10-15 percent weight on it and etc.

  10. Gary Wells on May 20, 2015 8:29 pm

    Hi Tomas,

    The only thing I can say is if you can walk on it then its ok to do it however DONT PUSH IT. Find your max and then go 10 to 20 percent behind that. Just saying that based on what has happened to me.

  11. Stuart on May 20, 2015 9:41 pm

    What you are doing is not unusual and you are on your way to a good recovery but I concur with Gary. It is still early days for you and the risk of re-rupture is high for another 8 weeks. I suggest you do some research when you have the time. Look up how tendons heal and early weight bearing protocols. This site has links to many of them or you can go to my page (Xplora)and click on the further reading tab. Of course the greater danger is when you come out of the boot which should be in around 4 weeks they way you are going. Hope it goes well and take it steady.

  12. Tomas on May 21, 2015 1:15 pm

    Thanks for reply. I just found a article regarding early weight bearing protocols - patients started FWB in 16.4 days in average… I started in ~25th. The research results are quite encouraging:


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