Is this common?

Well, five weeks post surgery, four weeks in a cast and I’m ready for a walking boot.   I’m thankful for crutches but will be happy to let them go.

The lingering question on my mind is how long till I’m FWB?  My surgeon does not elaborate on much and just wants me out of her office at $230 a visit.  Is this common with specialists?   Some tell me it’s par for the course.

How much I’ve taken for granted with sports and mobility!  My ignorance of tendinosis and too much, too soon activity playing basketball have led me here.   I’m thankful to be in recovery and pray that I can help others either avoid this ATR injury or help with their recovery.

9 Responses to “Is this common?”

  1. First of all, it is the duty of your surgeon to fully answer your questions. Ask for a detailed plan and don’t settle for less than that. They are not doing this for free. You have every right to ask for a full explanation and it’s their duty as a doctor to explain fully. I didn’t ask enough questions nor did I do any research immediately after my ATR and prior to going under the knife for the first time. By the time I got to the fourth time I was damn welled prepared and in the process fired on surgeon who wasn’t being honest with me about his intentions.
    That said, if you are going into a walking boot, will you still be using crutches? If not, then you will be FWB.

  2. +1 to everything Gerryr said.

    The protocol a few of us have been following here, which produced excellent results in a recent study with BOTH surgical AND non-surgical patients, calls for “protected weight-bearing” (in a boot) at TWO weeks, progressing to WBAT (full WB “as tolerated”) at FOUR weeks. Before 5 weeks in, I was forgetting where I’d put the cane that replaced the crutches — i.e., FWB.

    There are protocols that call for much FASTER FWB than that, mostly tested after surgery, and mostly showing benefits (and none showing disbenefits, AFAIK). Several are linked from the main page here, in the “studies” link. One metastudy showed the benefits of a “functional orthosis”, i.e., a HINGED boot, which is what I recommend. Blogger “gunner” here is one of several who have tried the new VacoCast or VacoPed hinged boot, and gunner and almost all the other users recommend it highly.

    Your “ignorance of tendinosis” may have led to your ATR, but the vast majority of ATRs come “out of the blue”, to athletes with no prior history of AT pain, weakness, or inflammation. (I’ve done “both sides now”, and both “out of the blue”.) And the hope that pre-activity stretching (or even warmups) can avoid ATRs, doesn’t seem to be born out by the evidence.

    If you’ve got a susceptible AT and you continually do the violent sports “moves” that put max stress on the AT, you’re likely to rupture it. If you’ve got a nifty way to keep it from tearing on any given day, it’s probably not going to be very strong the next time you stress it. . .

  3. Thanks Gerry and Norm, my surgeon did say post surgery that my tendon “did not look good.” She put me in a cast for 4 weeks and wants another 6-8 weeks with the walking boot. I’ll look into the recommendations of the Vaco products…

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

  4. Hi,

    3 to 4 weeks to walking boot sounds about right but everyone progresses at their own rate. Any longer sounds suspect unless you have a difficult case.

    I am 5 weeks post-op, ruptured water skiing, open surgery, haven’t started a blog but have read a lot of good info here and got leads on plenty more as well. The research has given me the confidence to start rehab and PT on my own. My doc has not exactly been open discussing “the future” and prefers to proceed slowly and take one step at a time. I can’t blame him but it’s my foot!

    At 3 weeks the lightweight splint came off and the foot went into a cam walker boot. I was supposed to be PWB with crutches but immediately went FWB on my heel and continued with crutches for a few days while I eased into limping heel-toe in the boot. At 5 weeks I am walking about as normal as can be expected in the fixed 90 deg boot. I wanted an adjustable hinge but doc wouldn’t go for it and the local supply house didn’t stock them anyway. Once out of the splint I also started passive ROM, then active, and now mild resistance with therabands and seated heal lifts without weight. Doc doesn’t know this but I will definitely get his advice before advancing to medium loads or walking in shoes outside. Unless I have problems I will probably skip office PT sessions altogether.

    I hate to think how tough rehab would be if I followed Docs last advice - too much time for atrophy. And, if I hadn’t known to massage adhesions I’d have a great big one now instead of a small one. I am using the more aggressive protocols that look safe and legit as a guides. You can find one here (not my doc) along with other good info:


    Happy PT!

  5. How do you do this “massage adhesions” / deep tissue massage to remove scar tissue?

  6. I would say FWB as tolerated as soon as you get into a boot. If you have a chance look up the VacoCast. It’s far superior to anything I’ve seen and well worth the extra cost. Order it yourself or get your doc to give it to you at cost since you recommended it. Very easy to walk in at 90 with a small lift in other shoe.

    It sounds like you’ve got one of the subpar docs who either doesn’t know or care about rehab. My advice would be to find a PT who will buy into Norm’s protocol and fire away. BTW, you don’t have to go see the doc every time he/she says to come back. I’ve cancelled several appointments since PT started. Just not necessary - there’ s nothing the doc could do.

    We’re going to have one final powwow in a couple weeks, doc, PT and me, to review the experience and maybe even write it up.

    As for prevention, I’m guessing that, given the abuse I subjected my AT’s to over the years, the only prevention would have been abstinence!

  7. mike-
    I started massaging with fingers and lube with great results initially. The remaining central area of adhesion is smaller and much tougher than the original periphery. Lately I’ve been using the cap of a Sharpie pen with lube to press hard and manipulate the dime sized area, a bit painful and progress has slowed, but I’m guessing better than waiting for Docs instructions. Moving in all directions is supposed to be important. It helps that sweetie is a massage therapist but I don’t let her touch it. Look up the “Graston Technique” to see where I got the idea. I think someone here suggested the handle of a butter knife as well.

    I almost ordered a hinged boot on my own but I think I’ll be out of the boot altogether pretty soon. I walk around the house barefoot but put the boot back on if I’m doing anything that takes concentration off walking.

    5 week post-op visit tomorrow, will be interesting…

  8. jski,

    thanks for the answer. Any links / url to those technic doc or video would be nice ;-)

    About your doctor - this’s just my opinion, but it looks like applies to almost 99% of us simple (no stars) people - you get doc attention at initial visit and surgery and the next post OP visit and that’s all. You might not get anything concrete after those visits and not many Docs even know in details recovery protocols - they rule based on 6 or even 12 months recovery time. They outsource you to PT for recovery protocol. And as many mentioned it’s already - PT is much more important in post OP / cast than Doc.
    As my Doc honestly told me - ” if about surgery it’s me, but if about recovery or tendon and etc than it’s PT, who has far more info for that matter.
    My point is don’t even try to extract much info from Doc, but concentrate on PT.
    Did you get PT? If not, ask your Doc about PT. Even Doc might tell you it’s too early for PT sessions, insist to meet with PT. It isn’t easy to find good PT for ATR - so try more than one PT - just talk to them and ask about protocols they will apply to you. Ask about other protocols that you like more and if any already has experience with it or will do it with you.

    What ever you do is good in my “fool” opinion.
    Just keep in mind every one is unique and not every protocol would work for everyone. Listen closely to your body / tendon!!! Don’t over do!!! this is really hard part to understand what is over do and what is not. That’s why good PT is the key who can evaluate you objectively.

    p.s. pls. create your blog that we don’t steal other posts ;-)

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