Week 2 - Good bye to the cast!

Doctors visit

This week I had my plaster cast removed, my moon boot installed and my first appointment with my sports doctor.

Cast removal

Cast removal

My Achilles is healing well, so - as is normal in New Zealand - I will be treated non-operatively. The protocol I will follow is:

- 2 weeks equinox cast (done!)

- 1 week at 30° plantar flexion non-weight bearing in the boot (NWB). Range of motion exercises completed for 5 minutes per hour from this stage.

- 1 week at 20° plantar flexion NWB

- 1 week at 10° plantar flexion NWB

- 1 week at 0° plantar flexion NWB

- Partial weight bearing at 6 weeks transitioning to full weight bearing at 8 weeks. Boot can be removed at night from 6 weeks.

- Transition to shoes with a raised heel at 8 weeks

I followed a similar protocol with my last ATR, with two key differences (1) my doctor didn’t intend to reduce the angle of my foot until week 6 - until I pushed for that to happen, and, (2) last time I had heel raises inserted in the boot, whereas this time I have an adjustable boot - which seems much more precise!

Bruising at 2 weeks

Bruising at 2 weeks

If you are in New Zealand, I highly recommend going  to a private sports doctor (e.g. Axis Sports Medicine), rather than through the hospitals/accident centres. The protocols vary widely between specialists. When I went to the hospital following my first ATR they told me I would be in a cast for 8 weeks! And the specialist who removed my cast this time put my boot at 20° instead of 30° - luckily that was only overnight.

Return to work

With both of my ATRs, I have had 3-4 days off work on sick leave and returned to work the following Monday. In New Zealand, ACC covers taxis from home to your workplace and to your medical appointments. This makes it much easier to get back to work, as my driving leg will be out of action until about week 10. At work, I have a leg rest (also from ACC) so I can keep my leg raised. I also try and spend some time on the ground - a funny sight in an office - to get my leg above heart level.

Taxi to work

Taxi’s everywhere!

Headspace

This injury is very challenging, both physically and mentally. I think I am quite a positive person, but this second ATR is definitely hard. One tool I use to help with that is the Headspace app. The app provides guided meditation and mindfulness programmes on a variety of topics. It has a rehab programme, which helps keep you mentally focused on recovery. I’ll try anything and everything to get back on two feet as soon as possible!

Exercise

In terms of cardio, I plan to start stationary biking at 6 weeks and swimming/water walking at 8 weeks. But, based on my last ATR, I need to do more to minimise muscle wastage in the interim.

Upper body and core exercises can be easily modified to be non-weight bearing (although you need to up your push up count when you are doing them from your knees!). I’ve also been getting in plenty of calf raises on my *good* leg.

Last time, I lost a lot of muscle in my glutes and upper legs - so, this week, I will be seeing a personal trainer to set up a programme for me so I can minimise that muscle loss. That should speed up my return to walking, running and netball!

Happy healing!

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