Swelling (& elevating) is getting OLD!


Written on April 30, 2010 – 11:06 pm | by normofthenorth

Yup, that’s the message! After 20 wks, my ankle is remarkably back-to-normal in almost every way, except for calf strength, which isn’t back yet.

But after a day of “normal” standing and sitting and a bit of “normal” walking, my leg feels anything but normal, until it gets stuck up onto a table or at least a footstool! My foot and ankle are visibly “fat” then, too.

I’m ready for this to fade toward. . . normal!!

BTW, I take a daily “baby” aspirin (to help with a congenital heart-valve problem) and two SMS tablets, partly to help with this leg inflammation thing.

  1. 27 Responses to “Swelling (& elevating) is getting OLD!”

  2. By normofthenorth on May 2, 2010 | Reply

    And yesterday again. I was hanging around at some other sailing clubs, while some Albacore (sailboat) class Measurers made sure our 5 suits of brand-new Albacore sails were legal. (They were.)

    And catching up with a bunch of sailors I hadn’t seen since September.

    Then maybe 45 minutes of supermarket shopping on the way home. Shopping seems like THE WORST activity for “needing elevation” — why is that? Standing seems worse than walking, and bicycling (or exercising) isn’t bad at all. Walking behind a shopping cart should be not that bad, with the walking, but I always feel remarkably WIPED when I’m through.

    For sure the shopping came AFTER all the other standing and sitting and driving (and no elevation).

    BTW, on the good side: this morning I took a moment to admire the little hollows behind my ankle bone. They seem almost back to normal, a lot like the other leg! So the swelling is (sometimes) down and the AT itself is getting thinner (as it gets stronger, replacing Collagen III with Collagen I, I’ve recently learned!).

    Five days ’til the first sailboat race! YAY!!

    I’m in charge of Fleet for my club, and I’m also in charge of one Albacore, one of our oldest ones that hasn’t been raced (or “State of the Arted”) for years. Everything needs work, and the sailing-club jobs have been colliding, work has been busy, and the weather hasn’t been cooperating (though it’s warm). Lots to do, and I’m here! (Bye!)

  3. By normofthenorth on May 2, 2010 | Reply

    BTW, returning to my MAIN hobby-horse — Surgery vs. Non-Surgery: If I had surprising discomfort from keeping my ankle low after ATR surgery, I’d blame all the slicing and sewing and rearranging from the surgery.

    But no, this is presumably mostly from the rupture and the healing processes themselves, with a little atrophy and re-development thrown in.

    Here’s a “glass half full” way of looking at this discomfort/nuisance. (Be patient! It’s me, after all!)

    The ATR is famous (and vulnerable) partly because it is poorly nourished by our blood supply.

    One theory I’ve heard for why ATRs happen is that the AT region is (badly) supplied with blood through two systems of blood vessels. One nourishes the bottom part, the other nourishes the top. And in-between, the blood flow can stagnate, which “starves” that part of the tendon and lets it develop a “weak link”, which then tears under high tension.

    Obviously this circulatory problem is often improved by the injury-and-healing process, because late re-ruptures seem to be very rare.

    But in addition, if you were trying to provide “new” blood (and oxygen and nutrients) to the ankle area, and flush away the “old” stuff, one way would be to “pump up” (inflame) the area a bit, then “drain it” again. (Kind of like rinsing the suds out of a bucket — or maybe a balloon! — by filling it and emptying it again.)

    And that’s just what we’re doing, isn’t it! (It’s STILL a nuisance, though!)

  4. By mikek753 on May 2, 2010 | Reply

    isn’t PRP has to activate this process and push at times stronger for rebuild?
    I didn’t take PRP, so I can’t say how it works or it isn’t.
    Just logical conclusion.

    However, at http://topnews.us/content/29844-prp-shots-not-more-effective-placebo-injuries-achilles-tendon-says-study

    said that PRP has no effect for ATR repair.
    Can we get the original study doc?

    However, I fully agree that good blood stream is the key for recovery. I just don’t know how to intensify this blood stream into tendon.
    May be later new surgery will keep AT exposed to artificial blood stream for period of time in some special environment?
    That way tendon can be monitored 24/7 and repaired in weeks instead of months.
    Week point here is skin tissue in AT area :-(

  5. By normofthenorth on May 3, 2010 | Reply

    Mike, I DID get PRP — 3 pricey injections — and I can’t say whether it works or not, either!

    The study I’ve seen reported — the same one discussed in the article you linked — used PRP to treat chronic Achilles tendinopathy, which may or may not respond the way an ATR does. For sure, a fresh tendon tear activates a bunch of healing processes (some of which depend on platelets and related healing factors) that aren’t triggered by any chronic condition.

    That’s why PRP MIGHT help with ATR recovery. Of course, the truth is in the facts, not the plausibility of the theory in the absence of facts. So it also might not help, but we won’t know until there have been a couple of careful randomized studies done.

    I think soft-tissue injuries often take months to heal completely, even when they’re in regions of the body that get lots of blood flow. And we’ve all noticed much more fluid (blood & lymph?) flowing through our injured ankles since the injury, which is why they often feel inflamed and hot after walking, standing, or sitting. It seems to be part of the healing process — though it’s also a nuisance, to be sure!

  6. By mikek753 on May 3, 2010 | Reply

    I’m not doctor, but S/W Eng.
    what I don’t understand is that when injured area is inflamed that’s when healing is done and we see that as swelling - isn’t it? Swelling is result of extra blood in this area - isn’t it?
    The blood what makes healing, actually blood stream that brings materials and oxygen for repair.
    Then - everyone was told to keep swelling in control. And every doctor and patient tries to lower swelling one way or another.
    Isn’t this reduce blood in the area - especially elevating in our case foot?
    That leads to lower blood stream - isn’t it?
    And as result should slow down repair process.

    I agree that swelling isn’t comfortable and comes with pain and no one likes pain.

    Is it trade of between pain and speed of body repair?
    Or I’m talking nonsense - Am I?

    The Q. is - how to increase blood stream and keep swelling under bay at the same time?
    Maybe exercises have to be done with ice pack around Achilles area all the time and not just after exercise?

  7. By normofthenorth on May 3, 2010 | Reply

    You’re from SouthWest England? (I’ve obviously misunderstood “S/W Eng.”!)

    I think inflammation is one of MANY natural functions that have both beneficial and harmful effects. The increased blood flow and circulation are part of the healing and reconstruction process, but the actual swelling can do damage to tissues, as well as restricting ROM and causing discomfort and pain. (The discomfort and pain might be partly beneficial, if it induces rest and elevation.)

    My latest pet theory is that INTERMITTENT inflammation may be especially helpful in a low-circulation area like the AT, because it would induce a kind of intermittent circulation, like rinsing out a bucket with repeated partial fill-and-empty.

    Fever is a beneficial response because many nasty viruses can’t survive (or can’t compete) at temperatures a few degrees higher than 37C=98.6F. But fever also causes harm to our bodies, and is routinely controlled with drugs and cold compresses, etc.

    The Histamine response we get to allergens — including the miserable runny nose and itchy eyes (etc.) — is life-enhancing because it helps us flush out foreign particles. But it also kills people with severe allergies, as well as causing serious discomfort.

    We are the descendants of survivors, so MOST of these tradeoffs have been made, over evolutionary time, in favour of survival of the genetic trait, regardless of discomfort. (If you don’t believe in evolution, then I guess you’d prefer a different explanation.)

    My fave example of this kind is motion sickness, or “seasickness”. This is, in general, the result of our brains discovering a mismatch between the visual signals of motion/stasis and the inner-ear signals of motion/stasis. If our eyes tell us we’re stationary (inside a bus or car, or “below decks” on a ship), but our inner ear tells us we’re moving, we get nauseous, i.e., our bodies usually tell us to empty our stomachs.

    Over a long history with lots of poisonous mushrooms etc. (that cause dizziness and disorientation before they kill us), and not many buses and sailboats, this reflex is clearly an evolutionary winner, even though it’s a bloody nuisance when we experience it!

    My PT put me in an ice-water “collar” when I was getting Interference-Current stimulation (early in my therapy). But recently, I’ve been told NOT to ice my mouth/gums after oral surgery (except for the first day or so), because it supposedly interferes with healing. That’s a first for me, but there might be some truth to it, I dunno.

  8. By mikek753 on May 3, 2010 | Reply

    that was for “Software Engineer” ;-)

    Thanks for the explain.
    Looks like there are cons and pros as always.
    If I don’t have seasickness - does it main I’m deaf on my inner-ear?
    Logically I believe in evolution - using breeding as proof to it.
    And based on evolution human going to extinct at some point due to better medicine that limits natural survival / selection and as result human body will be less and less immune.
    Unless future humans will be genetically modified to fight all viruses / bacterias.

  9. By normofthenorth on May 3, 2010 | Reply

    The thing that worries me most about recent evolution is the emergence of “sensitivities”. Like chemical sensitivies, where workers handling (say) epoxy or fiberglass resins become so sensitive to them that they get sick when they handle a piece of plastic.

    Like “bread-a-holics” who become Celiacs, and can no longer tolerate the gluten in wheat. I’ve run into enough examples of this “backwards” phenom that it looks like an emerging phenom to me. And it’s anti-survival. It’s hard to believe that we are the descendants of ancestors who had that trait, or we wouldn’t have made it this far.

    When natural omnivores like mice or rats are fed a diet of pure cheese (either during their lifetime or over generations) they generally get more and more efficient at squeezing everything they need out of cheese. (And ancient elephants adapted to become Arctic Wooly Mammoths and tolerate the extreme cold, to quote the science news of today!)

    If mice or rats instead became “sensitive” to cheese, we might not have as many mice or rats around today. . .

    Yes, advanced medicine has decreased the evolutionary pressure on humans (and some of our fave species), but I don’t think it’s reversed it. Some people still die in childbirth, and they don’t pass on their genes, etc., etc.

  10. By 2ndtimer on May 4, 2010 | Reply

    Agreed. Shopping is the worst thing to do with this injury. At least for 6-8 months. i had much more swelling issues with the conservative treatment the first time around. Maybe it is not just your age :-)

    Mike, I think the swelling is not the result of extra blood, but bad circulation when fluids (water) are not carried away as needed.

  11. By doug53 on May 4, 2010 | Reply

    How much fluid leaves a blood vessel is determined by two things, the leakiness of the vessel wall and the pressure difference across the vessel wall. Inflammation leads to leakiness and therefore swelling. Elevating decreases the pressure in the blood vessel. which helps decrease the swelling, but has no effect on the leakiness of the vessel wall itself. The amount of swelling doesn’t necessarily correlate with how much blood flow is present.

    I hope that makes sense,

    Doug

  12. By normofthenorth on May 4, 2010 | Reply

    2ndtimer, it’s a fascinating proposition that surgery may DEcrease the amount of swelling a few months later! My memory of swelling and elevation from 8.5 years ago isn’t great (that IS partly from age!!), but I can believe that it abated a bit earlier in the process, post-op. So it could be true, based on our tiny sample. Maybe the next randomized study should measure inflammation. (Some of them did measure calf diameter, but they treated it as a GOOD thing!)

    Doug, I’m not sure I understand the difference between inflammation and swelling (which I think I use interchangeably!). Inflammation is extra fluid inside the blood vessel, and swelling is extra fluid outside, in the surrounding tissues? Don’t BOTH make your foot bigger, and more uncomfortable? So how do you know which one you’ve got?

    If lowering increases blood volume in the vessels, and elevating decreases it, wouldn’t alternating between the two have a “pumping” effect?

    My own case is a bit complicated by some “varicosity” in my aging legs. So for a few decades, I haven’t loved “standing around” for long periods, because the valves in my leg veins aren’t as good as they used to be at making the blood flow back uphill. (An ATR may cure Achilles tendinosis, but it doesn’t cure varicose veins!)

  13. By mikek753 on May 4, 2010 | Reply

    Doug,
    What cause temperature raise in / around ATR?
    Swelling or inflammation?
    If swelling is bad than we have to minimize it as we can - isn’t it?
    However, as swelling - water / blood / etc outside of tendon than why the area is hot?
    Why applying ice calm down swelling?

    I have swelling and as result stiffness when I’m at work and my leg in vertical for an hour or even more.
    The good - I don’t feel pain when my leg in vertical any more
    The bad - as I don’t feel pain I’m forgetting to elevate my foot and as result swelling.

    How did / do you manage yourself to elevate the foot?
    When did you stop elevating the foot? at what week / month?

  14. By sullypa on May 4, 2010 | Reply

    Hi Mike

    My thoughts:
    Ice works to cause the blood vessels to constrict, thereby reducing blood flow, leakage and accumulation. Your swelling is likely the result of accumulation by gravity. The accumulation and swelling will occur until you rebuild the soleus muscle that acts like a pump, pushing the veins, and thereby the blood, edema, etc. from the ankle back up the leg.
    Accumulation and swelling hinder the healing process because they restrict the flow of fresh blood with its nutrients into the AT, and also hinder the flushing of waste by-products from it.

  15. By doug53 on May 4, 2010 | Reply

    The classic characteristics of inflammation are pain, redness, warmth, and swelling. Decreased function is also sometimes added to that list, and is particularly true with ATR. Redness and warmth are from increased blood flow. Ice decreases blood flow, and numbs the pain somewhat.

    Moving the leg alternately up and down might increase blood flow a trivial amount, with help from valves in the veins, but I doubt it’s worth the trouble.

    I didn’t do much elevating after the first week of two. I relied on compression to keep the swelling down. It’s a lot easier to get around with a wrap on your leg than it is with your leg up in the air.

    I hope this makes sense,

    Doug

  16. By mikek753 on May 4, 2010 | Reply

    now it’s looks like:
    1. ice just reduce pain and doesn’t help with healing;
    2. elevating reduces swelling and as result might help healing by reducing blockage;
    3. warm in / around area - healing in progress;

    but, I don’t understand about compression :-( how does it helps?
    isn’t compression reduces blood flow? and as result it will limit healing.
    Or somehow body reacts to compression in a way to limit swelling and that I don’t understand how it’s done.

    based on my past sport experience - almost for any injury we got compression for a day or more right after area was iced (some fluid that vaporized fast lowered temperature on skin and below).

    I asked my PT about ankle brace and got answer I should not use any support to allow full ROM for now - without applying much stress to Achilles.
    I’m not sure about compression sock or bandage for this matter.

  17. By normofthenorth on May 5, 2010 | Reply

    The last time I saw my non-op surgeon, he caught me on a bad day, and my ankle was inflamed/swollen. He suggested that I put it in an elastic sleeve (compression) to keep the swelling under control. I tried it a few times, but didn’t love it.

    I’ve tried icing a few times, too, always while elevating at the same time. That feels better, but it’s inconvenient enough that I hardly ever do it.

    But sticking my leg up in the air is often available, and easy enough that I do it often, usually a couple of times a day. Sometimes my leg still gets tired of the pressure on the back (AT!) side, but not very uncomfortably so. And the rest of my body gets tired of the bad posture, too.

    Mostly, I’m getting tired of doing it (and having to do it), which is how I started this page!

    Mike, I think compression reduces inflammation the same way squeezing a tube of toothpaste works!

    You know RICE? Rest, Ice, Compression, Elevation? I think it’s all based on the premise that inflammation, or at least uncontrolled or excess inflammation, is bad for our tissues, and not just uncomfortable.

    BTW, if Doug’s record-fast rehab was in any way CAUSED by his choice of compression instead of elevation or ice, then we should all be reaching for the elastic bandages!! (These small, non-statistically-significant samples are a B|%(#!)

  18. By sullypa on May 5, 2010 | Reply

    Swelling hinders healing. Swelling means the blood is accumulating in the outer soft tissues, and not flowing through the inner arteries, veins, and capillaries in the calf muscles and tendon.
    It’s somewhat similar to congestive heart failure, where the heart lacks pumping power and blood accumulates in the wrong places. In this case, the soleus muscle is the pump, and it’s strength has to rebuilt ASAP to avoid swelling.

  19. By doug53 on May 5, 2010 | Reply

    Swelling isn’t usually blood itself outside the blood vessels. If whole blood leaves the vessels, that is bleeding or bruising. Blood is made up of red blood cells floating around in plasma. Most swelling is when clearer fluid (very much like plasma), but not red blood cells, leaves the vessels and doesn’t get back in like it should.

    Doug

  20. By normofthenorth on May 6, 2010 | Reply

    As I just posted on ultidad’s blog-site:

    I bicycled a few miles today, and yesterday, mostly getting to my sailing club (and back) to get “my” boat ready for this Friday evening’s race — the first of the season! I was late for the ferry/tender on the way down to the Lake (Ontario), and pushing pretty hard on the way back up, and it all felt great! When I first started cycling, I was weak and out of shape and ankle-AT-nervous, but now it’s just a blast (again)!

    I do concentrate on putting in lots of ankle flexion and calf push, sometimes, when I think about it.

    A few times, I’ve even been surprised at the “easy speed” — the “zoom zoom” feel of the wind in my hair, or the speed rounding a corner, and how LITTLE effort it seems to take. I haven’t had that feeling since before the ATR, and it’s a hoot at 20-ish weeks!

    Tomorrow my PT puts me on the computerized machine that’s going to compare my healing ankle-and-AT’s performance to the other side. My ROM is pretty close to 100%, but I expect the various strength benchmarks to be maybe in the 45%-65% range. We’ll see.

    I am SO much happier recovering strength while biking and walking and running (yes, I’ve been doing a bit of that, too, mostly when I’m in a rush) than I am while pushing machines and doing multiple “sets” of multiple “reps”! So it’s a real blast to have reached that stage. I’m sure that adding sailing and racing back into my life will also be a delightful distraction from the AT-rehab.

  21. By normofthenorth on Jun 16, 2010 | Reply

    As I just posted at achillesblog.com/normofthenorth/2010/05/06/and-the-results-are-in/comment-page-1/#comment-199 , I think I’m finally getting over this swelling (& elevating) thing, at 6 months in — and High Time, too!

  22. By bronny on Oct 3, 2010 | Reply

    Normofthenorth - quick question, as you seem to know lots about this!

    I’m in NZ, 35yr old female, very active (squash, indoor soccer, windsurfing, mt biking, road cycling, surfing…) at 8 weeks tomorrow, conservative , 4 weeks in plaster 4 wks in moon boot, two of those weight bearing. I think it healed ok, well it was joined very fast (9 days, though with a divot at that time) and has never really hurt though i had a 6cm gap when i went to the hospital a couple hrs after the rupture.

    I’m wondering how much you’d have to do to re-rupture. Last night I accidentally overstretched and felt a twinge, its not swollen or anything today so i guess its fine? maybe just overstretched? Still feels whole. i’m just so scared of going back to square 1…

    thanks
    bronny

  23. By normofthenorth on Oct 3, 2010 | Reply

    Thanks for the Q, Bronny.

    The short answer is “Nobody knows.” If we had a solid answer, it probably wouldn’t help, either. Imagine I told you that it took 49 pounds of tension to rerupture the average non-op AT at 7 weeks, and increasing 12.5 pounds every 5 days. Great precise answer, but nobody knows how hard they pulled on their AT, either when we first ATRd, or when people RE-ruptured.

    Here’s what we DO know:
    1) Many or most of us had scares, and the vast majority of us did NOT re-rupture. Some of us trip and fall, or “catch” ourselves painfully, while NWB. Others overdo with exercises and stretching and PT. Some of us return to our professionals to check. Most are OK.
    2) I generally hate the “conservative” approach (though I love “non-op”), because it isn’t really safe, it’s usually just slow — and maybe even WORSE than a faster approach on the evidence! (Some people enter traffic on a big highway SLOWLY because they think it’s safer — we call them CRAZY and DANGEROUS!) But taking some “easy time” after you do something that causes pain or scary twinges, is probably a good idea in general. What that means in practice is a judgment call, of course!
    3) I’ve convinced myself that over-stretching is way scarier than under-stretching. For sure, healing long is considered worse than healing short. So after a while, I started just smiling and nodding my head when my PT prescribed dorsiflex stretches, and I didn’t hardly do them. I started that when my dorsiflex ROM got close to normal. The ROM on my new non-op ankle is perfect. (Calf strength, still a work-in-progress at almost 10 months, alas!)

    Check the UWO protocol at bit.ly/UWOProtocol for a good solid benchmark. Your schedule sounds close to UWO so far. I wouldn’t go much (or any) slower than UWO, because (a) their study got great results, and (b) the earlier studies that used slower protocols for non-op got much less great results, esp. higher re-rupture rates. Not to even MENTION that going slower is a bigger PITA!

    There’s also a whole blog page on re-ruptures, linked from the main page, so you can check out the stories of those who did rerupture for sure. If you have trouble finding it, ask again.

  24. By bronny on Oct 3, 2010 | Reply

    thanks Norm. Guess i’ll give the hospital a call and see what they think. I’m thinking i’ll just spend a couple extra days in the boot (i was due for 2 shoes with heel raises today).

    Funny wrt the surgical approach, people are so passionate about it. They don’t offer it as standard here (NZ) but i did some research, including the studies you list on your blog, and made a decision not to push for it (they will do it if you push hard). A friend who did his last week made the same decision. What amazes me though is people who are so convinced they are right about surgery and won’t hear of anything else. I was really upset by a few of these people in the early weeks after my decision, telling me it wouldn’t heal etc. I’m comfortable with it now but…actually i’m angry at them pushing their supposed knowledge on me. anyway…

    Can you tell me how to make a blog work on here, I signed up for one but i couldn’t figure out how to post or anything.

    cheers

  25. By normofthenorth on Oct 4, 2010 | Reply

    Your plan sounds reasonable to me, Bronny.

    Yes, people feel strongly about surgery vs. non-op. I think it’s partly because it’s so obviously logical that leaving the torn ends separated just CAN’T work out well, regardless of what the evidence shows. (There’s an old vaudeville joke that ends: “Who are you going to believe, ME or YOUR OWN EYES??” Too many people have a choice between believing their local medical expert, or the best evidence, but not both!)

    Add to that, the fact that all the OLD evidence was pretty solid in proving that “jocks” should get the surgery, and that it produced better results. The first of the new studies showing the opposite was only published 3 years ago, and two of them are still forthcoming — both presented orally at AAOS conferences (’09 and ‘10), but still not published in a peer-reviewed journal. That is really brand-new when it comes to scientific evidence — especially if you expect all the busy Ortho Surgeons to have already “gotten the memo”.

    Add in a few other exacerbating factors — the time-urgency of surgery, the fact that the “wrong” treatment never kills anybody, the fact that nobody specializes in ATR surgery, and the fact that most surgeons learned most of what they know as Interns, from an Attending Surgeon who’s probably already retired — and it’s remarkable that anybody is already getting good non-op treatment with a modern tested protocol!

    If the old wisdom were really true, I think it would be worth being “pushy” with our friends or relatives to make sure they got the best treatment, which certainly USED to look like surgery. I’ve certainly come across as “pushy” in the opposite direction, based on my interpretation of the new evidence, so I’m in no position to complain when others “push” their understanding of the facts forcefully!

    We all want to keep our friends from suffering, and most of us also want to be seen as experts. At least half of that is clearly a Good Thing, so try not to get too angry.

    The instructions on setting up a blog are on the main page, IIRC. Basically, you e-mail Dennis asking to set up one for you. He usually does that pretty quickly. Then you’ll see a “place-holder” blog listed under “Recently updated Posts” on the main page, with your name on it, and something like “Hello World” as a title. Then you sign in and open it up and replace the “place-holder” text with your own story, etc.

    Once you’ve got it set up, I think the more adventurous you are about finding and trying out the different options and tools, the better. Some of them aren’t obvious, or at least they weren’t obvious to me.

    For sure, install the “ATR Timeline widget” that displays your basic info — see mine near the top of this page. Some page styles make it disappear, so just choose another style until you can see it.

    BTW, I’m curious about how ATR surgery became “non-standard” in NZ. Here in Ontario — home of the UWO study itself! — we’ve still got LOTS of surgeons rushing ATR patients under the knife, and the Provincial health-care system just pays all the bills and smiles!

    Good luck, and good healing!

  26. By bronny on Oct 4, 2010 | Reply

    I’m completely lost on the blog thing - Dennis did set one up for me but i can’t find it, and when I did (a few weeks back) I gave up because I couldn’t get it to work at all even with the instructions!! I’m pretty computer literate too, but i’ve never used wordpress, maybe there is something i need to know ;)

    As for why surgery is non-standard here, and i’m speaking for wellington specifically not NZ as a whole: Well, they still use it for elite athletes. I guess the cost of getting it wrong is high. But for others they use the cast 4 weeks, moon boot 4 weeks (last two wks weight bearing with 2 raises), then shoes with heel raises 4 weeks. They check it every two weeks for the first 6 and again at 12. What I am a bit concerned about is i asked about physio and they said don’t worry until 12 weeks. What, from your experience, should i be doing wks 8-12? I walk on it and I take it out and wriggle it around invert/evert etc.

    Oh - the why its non-standard to do surgery - i reckon, cynically, they found a protocol that is much cheaper than surgical, so why wouldn’t they. Having said that, my flatmate did hers 6 yrs ago and she was treated in a cast for 8 weeks so maybe they have always been cheap, its just that the protocol has got more aggressive ;)

    thanks alot Norm…

  27. By bronny on Oct 6, 2010 | Reply

    Norm - another question, I’ve seen the protocol you are following but not sure what some of those things mean. Practically speaking, what exercises should I be doing? If I took that to a physio (and bear in mind I still have heel raises in shoes and only just in shoes at 8wks so maybe a bit behind?) would they know what it meant and where to start? My doc and the physio I spoke to at the hospital said I didn’t need to start physio till 12 weeks but I NEED to give myself the best possible chance of doing this right…

    thanks heaps…

    PS Is there a profile pic and details anywhere on your blog? I’m curious to know who i’m talking to.

  28. By normofthenorth on Oct 7, 2010 | Reply

    A PT should know what the techie terms and acronyms mean. If not, ask about some specifics here, while I still remember what they mean!

    About the schedule: I’ve suggested before that people who’ve waited much longer than UWO’s 2 weeks to start PT should probably start at the beginning, then gradually “catch up” by doing 2 or 3 weeks of UWO’s PT/exercises each week. I DON’T mean working your AT and calf 3x as hard as UWO, of course! Just doing the first week’s stuff for 1/2 or 1/3 of a week, then moving ahead to the next week’s, etc.

    Getting into 2 shoes at 8 weeks is actually NOT behind the UWO schedule (though they don’t use heel wedges in shoes). It may be only exercise and PT where you’ve gone significantly slower.

    Finally, about my pic and details. Like most people here, I’ve been cagey about sharing my ID. When you see photos or videos of people’s legs or exercises, you hardly ever see a face, and virtually nobody uses firstnamelastname as a loginID here. Maybe for most (and for me) it’s partly fear of sharing too much self-identity info on the open Google-searched Internet.

    OTOH, several posters here have sent e-mails directly to my personal e-dress, which I assume they got when the site notified them that I’d posted a comment on their own site. (I just looked, and I’ve gotten yours that way, and you’ve probably gotten mine, too.) So we’re only half “private”. E- me if you want to exchange life stories.

    Here’s what I’ve shared publicly here: I’m a 65-yr-old MIT grad, NOT a medical professional or researcher (except in my spare time), 2-time ATR patient — “both sides now”, once surgically with slow rehab and once non-op with UWO-Protocol fast rehab.

    I’ve been living in Toronto (Canada) for several decades, and I’m active in volleyball (which “got” both of my ATs), sailing and sailboat racing, kite flying, skiing, and bicycling around town. The V-ball and the racing are at a pretty competitive level, the other things Not So Much.

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