week 5 - cast off and in a boot with wedges

So I had my cast removed on Tuesday (4 weeks after ATR). I had to ask for a doctor to examine my tendon, they were just putting me straight into a boot. The doctor felt my ankle area and claimed the tendon was intact. I’m hoping he’s right but I wasn’t going to get a scan out of them.
I’m in a very, very heavy boot (NHS style) with wedges. To be kept on at all times - sleeping was disturbed again the first couple of nights. I’d gotten used to the cast!
They reduced the angle that my toes were pointing down and I’ve to take another wedge out in 2 weeks time, returning to the hospital in 4 weeks. The doctor said that they would be organising physio at my next visit - I think that meant getting organised then, rather than doing physio then! Still not to put any weight on that leg although they said I could gently rest that foot down for help with balance.
I’m not feeling very confident and I’m terrified I re-rupture the tendon or that it actually hasn’t rejoined. When the cast was off I had a very shakey leg and foot that had no movement capability - I hope that is normal. My tendon area was very tender when the doctor was examining (prodding!), but I’m not aware of any pain at any other time.
I don’t have much discomfort and I can wiggle my toes and push down (not weight bearing) through my foot, which I try to do to keep circulation moving. I still keep my leg raised when I’m sitting, which seems a lot of the time. My arms are aching with the extra weight of the boot - thought I’d got used to the crutching.
It’s hard to put trust in other people when I feel so much is at stake but the UK NHS is not open to patients taking control of their treatment, so I’m going to have to.

8 Responses to “week 5 - cast off and in a boot with wedges”

  1. Hi - I wonder which NHS is treating you ? There is a massive difference in your treatment and mine ! (i had a full rupture)

    For comparison my timeline is as follows:

    ATR on Monday 20/5/13 evening.
    21/5/13 Tuesday - went hospital and admitted.
    ATR surgery Wednesday 22/5/13.
    Next 2 weeks in Splint case post ATR surgery.
    Week 3 post op - stitches out and into Vacoped boot (NWB save to simply put foot down to balance)
    Week 4 post op - PWB able to put some weight through it.
    Week 5 - Boot setting moved to 15 degrees - FWB (ditched the crutches !) (advised to start gentle ROM exercises)
    Week 6 - Boot setting moved to 90 degrees - FWB (present)
    Week 7 - proposed +10 degrees and FWB in boot.
    Week 8 - In shoes hopefully.

    Do not worry about the shaky leg - that is normal from my experience ad what i have read - mine was very floppy!

    You will find from this website that earlier faster aggressive movement and FWB is better - See UWO protocol etc.

    I am being treated by Lancashire NHS.

    Happy healing !

  2. Hi musimaster
    I’m in Scotland - Paisley hospital. And yes, from what I’m reading, there are huge differences in treatments, and yes the more aggressive approach would seem the better.
    I also had a full rupture but this hospital favours non-surgery for oldies like me (50 in Aug), especially if sport is not a major part of your life. My friend who coaches did get the op.
    As you know, arguing with NHS staff doesn’t get you very far - scans have to be booked in advance and physio too. Each person has their own remit and won’t entertain anything beyond it. I was “lucky” to get the doctor to examine me.
    I suppose considering I didn’t get operated on, I’m not too far behind you, though I’m guessing that I’ll not be in shoes at week 8!
    I’m just into week 5 and where you were at week 3 with my foot moved from equinus, not sure to what degree.
    The nurse showed me the full set of wedges that came with the boot and said that was how my foot had been and then he took at least 2 wedges off at that point (might have been 3 - was all a bit quick and I was still recovering from seeing my shakey wee leg, lol and the doctor manipulating my leg).
    You know it’s a production line - they want you in and out asap.
    Have you asked to follow the UWO or was this the protocol your hospital follows anyway?

  3. Pam all your feelings about re rupture tendon not healing 99 percent of us go thru the same thing, I think the mind is the biggest issue with this injury, I went private and didn’t get scans etc, was in breg boot very heavy
    8 weeks in shoes is the normal

  4. thanks ripraproar, I know you’re right about the mind being the biggest factor and of course everyone heals at different speeds. I’d love to be in shoes in 3 weeks time or sometime soon after that. I suppose it’s the lack of information about the hospital plan that doesn’t help.

  5. Hi, I agree with Musimaster. I had a complete rupture of my tendon and when I came out of the cast my leg was very weak. So, dont worry because once you go to the boot you will be able to really exercise your foot more and gain strength in you leg. You may be surprised of how quickly you gain strength back in you leg. I am at week 5.

  6. Oh Pam

    Most times you simply don’t need a scan - I had one to confirm the initial diagnosis, but none during my recovery period. The doctors and physio’s can tell if it is coming together ok.

    As for your boot, you’ll be delighted to know that these days, there isn’t really an NHS type! The difference is down to the individual trusts, their budgets, and the knowledge base to enable them to move forward, utilising the latest technologies and treatments. My boot was a Vaco boot which weighed about 6 pounds (2.8kg), and can now be found in an increasing number of NHS hospitals. Every part can be washed or cleaned easily, and can be worn in the pool (check out YouTube).

    What are you proposing to do to ‘take control’? Do you have copies of the latest protocols? Check out this blog for UWO, and posts this week from Suddsy and me regarding even more recent stuff, and results from Exeter.

    If you’re going to challenge the regime you need the ammunition. Raised voices and no evidence will achieve nothing as I’m sure you are already aware.

    Also obtain a written protocol from your hospital and try to establish a relationship with the physiotherapy team - during the recovery period, the pt’s should be in a position to help you, and give you confidence, more than the doctors.

    Mobilise asap, don’t do anything silly, you’ll be fine, maybe fitter than before so long as you don’t sit on your backside too much!

    By the way, don’t feel disadvantaged by not having surgery which has its own potential downside, and doesn’t appear to give a quicker repair - check out those results.

  7. I agree re the very different treatment in the NHS dependent on where you live. I am non surgery and I decided that I wanted to go into a Vacoped boot so I bought one on Ebay and took it along to my NHS hospital (Derriford in Plymouth) at my 2 week appointment. They were only too happy to let me go into it instead of their standard issue Aircast. They told me that they would like to give all of their patients Vaco boots but that they couldn’t afford to switch.
    I have not had a scan either but the doctors think that my rupture is pretty high up. As a result they put my boot into a fixed poition of 15 degrees and said that I could FWB. 3 days afterwards I stopped using my crutches (I bought an Evenup for my other shoe to equalise my height with the boot). After 4 weeks I went back and they put the boot at 0 degrees - 10 degrees. The Vacoped boot is hinged and allows a variable setting. I have been moving the setting by 5 degrees each week and I am now at 0 - 20 degrees. I should be getting into 2 shoes by week 8 but I am on holiday so have put that back to week 9.
    My experiences with the boot have been good. It is very easy to clean as Hillie remarked and has 2 soles. One is designed for Achilles treatment and makes it very easy to walk without crutches. The other is much lower and very useful when I go to the gym and want to use a rowing machine or exercise bike. I have even managed to drive a manual car with the flatter sole (only on my own property of course ;-)
    I measured my calf muscles when I first had my injury and my left calf is still the same circumference as my good right calf. I know this doesn’t mean very much as far as muscle effectiveness is concerned, but i think that my boot has made a difference to the state of my calf muscle - only time will tell.

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