Wait, Weight, Walk
So today was 5 weeks post operation & Non Weight Bearing and my second appointment. My surgeon’s on holiday so I didn’t get to see him, instead it was a date with my plaster technician. As I waited in the foyer I got a case of those horrible hospital nerves even though I knew I was in no serious danger! I knew that I was going to have my foot repositioned into neutral but I did NOT foresee the pain that that would cause me! As the technician pushed my stiff foot back I squealed as I asked him if there was any chance that this rigourous pushing would make my tendon re rupture! He said he wouldn’t do it if he feared it would snap so I put as much trust in him as my fear would permit me to. Eventually we got it to 90 degrees and I was recasted and given a shoe to wear over the cast.
He encouraged me to put weight on but I was too afraid! I’ve been told to walk with one crutch and gradually wean off it. I’ve tried walking and it’s definitely tricky! I feel like a baby learning their first steps again.
Now my dilemna.
On the car journey home, my dad suggested pulling out of the holiday I’m due to go on with my friends next week - he doesn’t think I’d enjoy it much in my current condition! I don’t know what to do. I really don’t want to fly and spend 3 and a half weeks in a hot country with a big cast on! I’m going to call my surgeon on Monday and ask him if there are any alternative supports I can have that will enable me to be somewhat involved in the trip. I also want to be able to walk with as little a limp as possible so I’m going to be up as much as I can, obviously not pushing myself though. I already missed my Prom because of this injury AND had to sit the most important exams of my life in post op agony, I don’t want another part of my summer to be ruined too!
- Kristy
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Kristy, if you’ve been following things here, I think you already know what I think! The ONE rehab variable where the studies DON’T seem to show better results from going faster, is the one where you’re going fairly fast — and suffering from it! Early WB seems to help, early mobilization and early PT seem to help, but early shifting of the ankle angle while weighted has not been shown to help, at least in any study I remember seeing.
The UWO protocol several of us here are following — posted at bit.ly/UWOProtocol — maintains plantarflexion in the boot (not a cast!) for a full 6 weeks. But PWB and mobilization exercises and PT all start at TWO weeks, and you would be FWB by now — still with 2cm of wedges under your heel, but FWB — if you were following it. And it produced great results in post-op and non-op patients alike, so why do Doctors (and some whole COUNTRIES!) insist on going so much slower? AAAAAARGH!!
The good news is that most people do outlive the initial pain of adjusting to a less plantarflexed angle in the boot or cast. You’re probably wise to stay off it until that happens, I think. “Sleeping on it” often helps more than walking on it, so it might even be significantly better tomorrow.
Another functional advantage of boots over casts is that it’s way easier to make the ankle-angle-position shift GRADUALLY, because each change is either a notch in the hinge of a ROM hinged boot, or the withdrawal of one heel-lift wedge (of several) inside the easily-opened boot. (One of my few complaints about the UWO protocol is that it goes “cold turkey” on heel lifts at 6 weeks, rather than spreading it out over a few days, as I actually did.)
And of course, if you’d been doing exercises and PT (easy with a boot), according to that protocol, you’d have been gently moving your ankle up to the neutral position for the past 3 weeks, so it wouldn’t be a painful shock to shift your position now.
I’d print out that protocol, roll it up, and slap your surgeon with it!
8 yrs ago, after my first ATR (and surgery), I spent over a week in Florida, Gulf Coast, in a hinged boot. I was VERY attractive, with plastic shopping bags over my boot AND over the other “elevator shoe” I’d built up so I didn’t kill the rest of my body by walking lop-sided! But by then, I was even RUNNING on the beach in that getup, so I had a pretty good time. (I was a few MONTHS farther along than you are, though, in fairness.)
I hope you get some relief, and that you can go on the holiday and have some fun. Good luck!
Hey Norm, thanks very much for your reply. You were right, after a good nights elevated sleep the pain is a lot less and I’m feeling confident enough to walk around the house with one crutch. About the protocol, maybe I’m a bit too far gone to switch now? One thing I do wish wish wish for is a boot! But my insurance doesn’t cover it and my parents don’t want to pay for it as it’s quite expensive, so it’s casting for me!
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PS You wouldn’t happen to have any advice/tips for how to go about walking at this stage? At present I’m trying to press heel first then kind of follow through with the rest of my foot but I’m not sure if there’s any particular technique I should be trying to master!
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Glad the pain subsided overnight, Kristy!
I think you can get a good fixed boot for around $100, and even a hinged one for close to that, online. Still a lot of money for a teenager, I guess. I’m not sure how much the protocol can help you now, either, especially in a cast.
The basic technique of walking in a “walking cast” (this one is fiberglass, right?) is the same as walking in a boot, and it’s just the way you describe. Plant the heel first, then roll over your foot, straight ahead, straight forward (unless you normally walk at “10 to 2″).
The strength for the “toe push” that your calf and AT would normally do (and DO do on the other side) is provided by the cast, mostly the top of the “cuff” pushing against your shin.
One of the important “tricks” is to make your walking as normal as possible. Don’t mess up your alignment, and don’t “master” any new ways to “gimp-walk” or “funny walk” that you’ll have to UNlearn later. And find a way to elevate your “good” foot so it’s as far off the floor as your casted foot, or you’ll mess up your alignment. Extra footbeds in a high clunky shoe or boot might do it. I did that, and also I stuck a sandal inside a Velcro-and-canvas “cast shoe” that’s sold in med-supply stores for around $5.
As you gradually feel stronger, you’ll naturally start “pushing off” against the bottom of the cast, with the ball of your foot, putting less pressure on your shin from the top of the boot. I wouldn’t try to win any prizes for rushing things in the next few days, given your pain at moving into this position.