2 Weeks and 1st Follow Up

I went to the clinic on Friday and the doctor took off the old plaster cast. It’s been switched to a hard blue fiberglass cast. The new cast is considerably lighter which is quite nice. I though the doctor would put the foot into a 90 degree position, but she only adjusted it a few degrees. She says I’ll be in this hard cast for another 4 weeks with NWB. So in total 6 weeks in a cast. Then she’ll switch me into a boot for another 6 weeks. I think she mentioned that she doesn’t want me bearing weight on the foot for 12 weeks in total. Is it me or does that seem a little long?

On another note, it seems my foot is still swelling. (After 2 weeks!) It had gotten better, but as of yesterday, the swelling’s coming back again. It seems okay during the day, but right before I go to sleep and when I wake up, my leg feels quite swollen. Which is strange since I have my foot elevated.. Am I not sleeping the right way?

As of now, I’m keeping it elevated and wiggling my toes, hopefully it’ll get better again..

Michael

7 Comments »

  1. highflyer Said,

    October 11, 2009 @ 10:52 am

    Hi Michael,
    It does seem very conservative to be 12 weeks NWB, unless you have some very severe problem I think that 6-8 weeks would be about right. Also 4 weeks in the same cast seems a long time (your calf will waste anyway & make the cast loose). Suggest you go to see them in 2-3 weeks & get the cast changed. This may speed up your recovery. Of course if your Doc has some reason for this time-scale then listen to what they say.
    All the best.
    Chris

  2. 2ndtimer Said,

    October 11, 2009 @ 12:44 pm

    Hi Michael,
    I always experienced a fair bit of discomfort after the cast change, for the first 5 days or so, then my foot got more used to it. It is very annoying. However if your toes are not purple when you elevate them, they return to normal colour fast, then the cast is probably fine.
    I am a bit puzzled though why your doctor plans to keep you in cast for so long, as you had surgery and are very young. Unless you have some other health issues you may want to question why she wants you to be NWB so long. I agree with Chris’s suggestion to try to rebook your appointment for 3 weeks as opposed to 4. The muscle atrophy is very hard to fight afterwards. I am in Ontario, too, and my surgeon said his standard practice is 1 month in cast 1 month in boot after surgery.
    Good luck!

  3. ultidad Said,

    October 11, 2009 @ 7:19 pm

    Michael- wow, at your age, I would’ve expected your surgeon to be moving you along a little more quickly (unless I am wrong that younger people heal faster than older). I was allowed to go the boot (PWB) 2 wks post-op and to get rid of the boot at 5 weeks. I questioned my surgeon about the different approaches that I have encountered here and I’ve posted his reasoning here: http://achillesblog.com/ultidad/2009/10/08/woohoo/. Maybe you can ask your surgeon her opinion of the research. Good luck, Ron

  4. michael784 Said,

    October 19, 2009 @ 7:45 pm

    Thanks for the info! Yes I was surprised as well, since I’ve been quite healthy and I’ve never had any other injuries except this one. I will try to ask her on my next follow up. I think maybe one reason is that I’m young and the doc thinks I’ll probably rush or forget and injure myself again?

  5. Brandon Lazzaro Said,

    June 2, 2010 @ 12:30 am

    I am 24 years old and my surgeon has opted for the conservative route as well. She says it is because the retraction was so far apart and that it took me 3 months after injury to have surgery.

  6. normofthenorth Said,

    June 2, 2010 @ 1:54 am

    I’m pretty sure there’s no scientific-statistical evidence to validate the notion that slower rehab and/or longer immobilization or NWB are beneficial to people with big ATR gaps or long delays before surgery. This strikes me as a reasonable-sounding professional judgment in a field where many if not most of the reasonable-sounding professional judgments have been proven false.

    And as far as speed-vs.-outcome is concerned, the studies have pretty consistently shown that the doctors who think they’re being “conservative” — i.e., minimizing the risk of re-rupture and optimizing the ultimate recovery — aren’t really, they’re just being slow. That doesn’t prove that she’s wrong about you, but it does make me wonder if she’s read and understood those studies. (Most surgeons are too busy to do much of that, in my experience.)

  7. gunner Said,

    June 2, 2010 @ 7:47 am

    Brandon: Can you elaborate on the 3 month gap between injury and surgery? What sort of treatment did you receive?

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