When is it ok to lose all heel raises?
I was put into a boot with 3 heel raises at 10 days after rupture and told by my consultant to remove one a week and to go back to see him after 4 weeks. I was slightly freaked by the idea of 3 and chose to use 4 at first although quickly dropped to 3 after a couple of days, and have been removing them one a week since then. This means that I ought to be taking the last one out today, which would put my heel flat at 4 weeks and 4 days. This feels early compared to what I have been reading on other people’s posts and I wondered whether anyone had any opinions or whether I should just trust his recommendations?
I am totally torn between feeling good about my progress (feel very comfortable doing short steps across room without crutches) and then wondering whether or not my achilles is healing or whether I’m going to get a hideous shock next week when I see the consultant. I was advised that I could move to partial weight bearing “as tolerated” over these 4 weeks between 1st and 2nd visit and again, I am wondering whether this is too fast and I should take it a bit slower?
Would love to get any thoughts and advice that people may have on these two questions and thank you in advance if you can spare the time!
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Parisski, we now have two good modern rehab protocols posted here, that have both been tested in recent randomized-trial studies. They both seem to have produced good results with and without surgery. (Unfortunately, I’m still waiting to get the complete studies, so I’ve only seen summaries of the precise results.)
My general recommendation to people in your spot is to stick with a recipe that’s been proven to produce tasty results! The two protocols are (1) the one used in the large and very recent “UWO” study — posted by me at bit.ly/UWOProtocol — and (2) The one used by Bruce Twaddle et al in NZ in 2007, recently posted by Bronny on her blog.
They differ a bit from each other, as you can see by comparing them. As I recall, Twaddle was quicker at removing heel lifts than UWO, but slower at getting to FWB, without crutches. I’d love to (and I plan to!) compare their precise results, then recommend you “go with the odds” and choose the one with the better results. Haven’t done it yet.
I’m also having trouble figuring out exactly how far into your rehab you are now, from your posts. Two suggestions: (1) The key date for your rehab is when you were immobilized (or operated on, for the post-op folks), not when you tore your AT. (2) There’s a nifty “widget” available on the site called the “ATR Timeline” that automatically calculates and displays both those intervals (post-ATR and . . . “post-OP”) as well as some basic info about you and your leg. That info is very handy for us readers. Instructions on installing the widget are on the Main page, maybe paragraph 3. (If you install it and it doesn’t appear, it’s probably because your chosen “Theme” is incompatible with it. Try another theme.)
My opinion is simple: If you compare your timeline to a tested protocol that produced excellent results, and you’re being told to go faster, you’re probably right to be nervous. I’d go with the evidence. If not, you’re going with the evidence, so you can have some confidence.
BTW, Bronny thinks the Twaddle study only included maybe 40 patients, and the UWO study included 145, so if they had identical excellent results, I’d lean toward the UWO study. (I’ve seen most of the UWO results in earlier publications, and they seem very good. The abstract of the Twaddle study has no specific numbers, just that the non-op results were the same as the post-op.)
Finally, UWO’s precise approach to heel lifts — 2cm of wedges for 6 weeks, then they all come out at once — is more abrupt than most. I personally don’t see any benefit from the all-at-once “cold turkey” part of it. I followed that protocol, but I actually spread out the wedge-removal part over a few days, which felt much better to my leg.
Good luck, hope that helps.
Hi Normofthenorth
Thanks very much for your comment - it’s really helpful and I think i am going to keep this last heel raise for a few more days. I have also added the ATR timeline widget as you suggested. I ruptured my ATL on Saturday afternoon, 2nd October at 4.48pm and was in an equinus cast by about 8pm the same night. I then had 3 more casts over the next 5 days - all in the same toe pointing down position until I confirmed the no-op route and got put into the boot at 10 days with 4cm of heel raises, supposedly reducing by 1cm a week until my next consultation which is on Monday 8th November. This doesn’t seem to be following either of the protocols, although I have to say that I have had no pain since the excruciating pain of the rupture and then the dull ache in the back of the calf for the first couple of weeks. The most pain (following the rupture) was when i had 4 heel raises and they were pressing continuously into the ball of my foot (resolved problem by switching to the shortest heel raises rather than the long ones - doh!)
Anyway - will definitely take the UWO study to my consultant and ask him how his protocol fits with this study - it’s great to be so well armed with info from the wealth of posts from you experienced ATR bloggers. Thans very much indeed.
Delighted to help, Parisski!
Your funny story about getting poked by too-long heel wedges reminds me of an old joke. A VERY old joke. Patient to doctor: I get a sharp pain in my eye every time I drink tea. Doctor to patient: Take the spoon out of the cup before you drink the tea.