Feb 29 2012

cast is off - vacocast in on - nwb for another month (atr+24 | op+18)

Published by michel at 10:46 am under Journal

I went back to see my surgeon yesterday afternoon.
My cast was removed, as well as the stitches.
When they removed the cast I looked at my calf, ankle and foot and couldn’t believe they were mine: they haven’t been this small since I was 10 years old I think :)
Wow the entire lower leg is atrophied *a lot*… I also lost about an inch to my left quad… beurk :(
When the surgeon took my foot and told me to press again his hand I was scared s***less that I couldn’t put much pressure at all.
The scar looked good I’m told, with no signs of infection or anything, and relatively smooth.
The nurse then proceeded to clean my foot, and reapplied dressings after using some tape to make sure nothing reopens.
I’m starting physio this afternoon. Again I’m scared about them putting too much pressure too soon and something going wrong :(
The doc told me that since the tear was a complete one, at the muscle-tendon junction, he didn’t want me to put any weight on it for another month. I’m starting to have all sorts of little pains around my knee because of always keeping the leg up when crutching around with the cast, and now the VacoCast putting additional weight on there.
The marathon tracker plugin says I have completed 1.29 out of 26.2 miles to full recovery… man it’s going to be a long one.
Let’s go.

5 Responses to “cast is off - vacocast in on - nwb for another month (atr+24 | op+18)”

  1. Januson 29 Feb 2012 at 1:14 pm

    Hang in there! Sounds like you do have some good news: no infection, no obvious signs of any post-surgery complication.

    As for the muscle atrophy, my experience the same — when I saw the leg with cast removed, it seemed more suited for say my 12 year old niece (the skinny one).

    As for it being a long recovery, well, I’m expecting the same very much so in my case. Spoke to some people who have told me — give it a year to get back to where you were.

    Many people on AchillesBlog have made better progress, I should point out. But right now if it takes me a year to recover fully, it’s still worth. I had to live with this injury a bit before surgery. And the prospect of not being able to walk properly (forget my running & sports!) was so frightening that I’ll do what it takes to get this healed, done, and largely out of my life.

    That said, many many people have had all the same challenges and more that you and I face, and have done just fine with it. Fully recovered and on with their lives. In the long run, just a speed bump.

    & I’m finding the time goes fairly quickly: this Friday, one more wedge out of the boot, and a prescription for PT. From surgery to my first appointment to now seems to have blurred by.

    Wishing you the best, and a full recovery that will seem speedy enough when it’s over. Cheers!

  2. normofthenorthon 29 Feb 2012 at 1:39 pm

    Many surgeons find reasons to prescribe slow rehab protocols. Mostly I think it makes them feel better! ;-) The authors of the UWO study mined the data on their non-op ATR patients who’d had pre-treatment ultrasounds. Their Q was whether the SIZE or the LOCATION of the ATR gap — ALL their patients had complete tears, no partials — had any influence on their clinical outcome (strength, ROM, rerupture rate). They found NO influence, with all the patients following the same fast protocol. It’s hard to believe that your sutures made your calf-&-AT WEAKER than those non-op patients, some of whom had high ATRs like yours.

    It “feels right” that waiting longer NWB will produce better or safer results, but what little evidence we have (just this one sub-study, and small numbers) does NOT support that gut feeling. I’d share that study with my Doc, IIWY.

  3. ryanbon 01 Mar 2012 at 10:08 am

    In addition to what Norm says about getting toward weight bearing early, my recommendation is to try and keep the joint mobile. I think this can help with atrophy.
    Don’t load up the injured tendon- but keeping it moving shouldn’t hurt it. Actually, I think it will help- keeping structures that are supposed to move, relative to one another, from fusing together with scar tissue.
    The boot is kind of like a helmet- when you’re in a very safe environment (say watching TV on the sofa), take it off, and move your foot around; perhaps drawing the alphabet in the air with your toes.
    The other thing I did to help regain control of the muscle was to lightly press into my calf with my fingers, and then try (with my calf) to flex back and resist that pressure. Practice on the healthy side first. You can press at different locations, and from different directions to engage different parts of the calf. Post surgery, it was almost frightening how little control I had on the injured side. This was something I could do early that didn’t seem to cause pain or put large forces on the injury.

  4. michelon 01 Mar 2012 at 3:15 pm

    Thank you Janus, norm and ryanb for the encouragement :)

    I actually went for my first physio appointment yesterday afternoon, and we took the boot off and started working on the periphery of the AT:
    - getting mobility back in my knee, which was a bit stiff and wouldn’t let me get my leg flat on the table: now ok and doing some exercises to remain that way.
    - getting my vastus medialis moving again, as even though I had kept moving the leg with the cast, it seems this guy had disappeared. Now I can look at it and make it move just like before.
    - getting rid of inflammation and blood accumulation around the ankle with electro therapy and good old ice - that felt really good once done.

    I’ll put up a post with the suggested exercises and if I’M brave enough a couple of pictures I took last night on the couch while doing exactly what you suggested ryanb. My calf isn’t responding but I’m sure we’ll get to it next week at my next physio appointment. In the meantime I’m lightly massaging it when the boot is off.

    As for being more aggressive in the scheduling of PWB, while I really want to get moving as soon as I can, and my father even told me that in theory I should be able to put a bit of weight on my leg starting this week, my surgeon told me that in my particular case he didn’t want me to put any weight on it for a month, as the region where the tear was is particularly friable. The guy repaired both of Olivier Panis’s legs after a crash at the Montreal Grand Prix and is the OS for the Quebec Ski Team, so I have 100% confidence in him and will do exactly as he tells me. Might take a bit longer, but my ski season is shot anyways so… I just have to keep the morale up :)

  5. normofthenorthon 09 Mar 2012 at 2:52 am

    Michel, if it helps, the abstract of the study I referred to above is at proceedings.jbjs.org.uk/content/91-B/SUPP_II/244.1.abstract . The last listed author (K. Willits) is the lead author of the UWO study (which was finally published in 2010). I THINK I’ve seen the whole text of this study, too, but I can’t find it now. Your surgeon’s not wrong about the friability of the proximal part of the AT (and the calf-muscle heads), but this study suggests that it does not influence the clinical results of a fast rehab, even without surgery. Me, I’d share it with my hotshot surgeon, FWIW.

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