We all heal differently - 5 weeks post rupture and no more crutches
I saw my consultant yesterday, 4 weeks after he put me in a boot, 5 weeks after my rupture, and was hugely relieved when he said that my achilles was intact. He advised me to put away my crutches and spend only one more week in the boot before moving to 2 shoes (plus a saftey crutch) and physio from week 6. This was hugely reassuring as I have increasingly been feeling confident about walking without crutches (from week 3) and was worried that it didn’t seem to follow “normal” patterns. I told him how much I was appreciating this blog and how I was interested in monitoring my progress and protocol against that of others. He then said I need to be careful not to compare apples with oranges as we are all different, our ruptures will be different and each of us will need protocols relevant to our individual situations. My rupture was right up near the calf muscle and therefore will heal in a different way (and speed) to ruptures lower down in the achilles. In particular, a tear near the calf is fuelled with the extra blood supply from the calf. I am really nervous about moving to 2 shoes as I feel so protected in my boot - however I slept without my boot for the first time last night and it was absolute bliss. Is anyone else recovering form this kind of rupture? Would be fascinated to compare notes. Have loved being able to make my own cup of tea in the office and carry it to my desk for the first time in 5 weeks - amazing what a boost such small things can be.
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Of all the many steps along the voyage, the step from PWB to “crutch-free, cup-carrying FWB” is probably the most liberating and joyful!
Congrats on that, and enjoy it!!
We are definitely all different! I think my two legs are even different! But I still like staying close to proven “recipes”, I do. It’s true that your tear is in a circulation-rich part of the leg, whereas most of us tore our ATs in the “watershed zone”, where the blood circulation stagnates and the AT tends to become “starved” and weak. That’s all true. But it’s also true that the UWO researchers applied the exact same protocol to all their subjects, regardless of the location or gap-size of their ATR, and they did well, overall, even without surgery (like you).
And when they double-checked to see if the original location (or size) of the tear had any impact on the eventual results (strength, ROM, and re-rupture rate), it did NOT. Maybe the folks with high ruptures could have done even better by going even faster, but I’d call that more a hypothesis than a proven fact.
From my casual sampling, mostly on this site, I think most Doctor’s protocols are more customized to the individual Doctor than to the individual patient, or the leg!
I would never suggest that you should do anything because it’s “normal” or “typical” or “common”. But doing it because it’s “tested” and “proven” does seem sensible to me.
In any case, right now, 4-ish weeks post-immobilization and FWB in the Vaco, you’re temporarily back on my fave schedule. If you go to 2 shoes in the next 2 or 3 weeks, you’ll be ahead of it again, and I’d certainly advise caution.
Parisski, your timeline confuses me. The widget shows 5 wks & 4 days post-ATR and since treatment began. Your first blog entry said 2 weeks passed before you got the boot, and the entry above says 1 week passed. Were you immobilized in a cast promptly after the ATR happened, then shifted to the boot later? (If so, the timeline is right.)
Hi Norm. Thanks for your comment - makes lots of sense. My ATR happened on 2nd October and I was immobilised in the cast on the same day and moved to a boot on 11th October - so I think the timeline is right. I have confused matters by referring to two different dates in my posts. My only worry now is your comment about when I go to two shoes? I will be 6 weeks post ATR when I move to 2 shoes, which seems to be ahead of the UWO shedule, and one week after FWB (although I was doing a fair bit of FWB from 3 weeks in reality…). I have been advised to use a crutch again when I move to two shoes for 3 reasons: 1. to provide stability 2. To remind me not to overdo things and 3. to warn others away!
You and your Doc definitely have the right to go faster (or slower) than my fave protocol! I just have a strong personal preference for keeping near the path that was proven safe in a good study — a preference my fancy Doc shared, even more strongly than I. (He wasn’t supportive when I used my old HINGED boot as a transition from the AirCast to 2 shoes, but it felt great to me, physically and mentally, so I did it, and I recommend it.)
That protocol says “wean off boot” at 8 weeks, and “return to crutches as needed”, or some such. I didn’t want to pull the crutches back out of the basement, so I didn’t. Instead, I used the hinged boot as my transition tool — first using it whenever I went out, then only using it when I went to “scary” places, then putting it away. “Weaning”.
The best use of a crutch or cane during this upcoming transition is as a warning flag to keep you from getting tripped when you finally go to scary high-traffic places in 2 shoes. I tried it WITHOUT the cane, and got kicked once in the back of my “bad-side” shoe, by a rushing subway passenger! I was THIS CLOSE to tripping and “face planting” right over that foot, and doing God-Knows-What amount of damage to the AT and other body parts! A cane would have kept that clown away from my feet — or at worst I could have smacked him with it!
BTW, it’s not hard to get out of alignment with one crutch — especially if you use it on your “bad” side, as some people recommend. There was a spare cane in the family, which I used instead. I didn’t love that, either, but it didn’t last long, maybe ~2 days. And ALL of that was during the transition from PWB to FWB, in the boot, not in the transition to 2 shoes.
At that stage, I think the cane or crutch should be a red flag, period. Your 2-shoe gait will probably start out short and lop-sided, and gradually transition toward “normal” and “perfect”! By THEN, you’ll be able to start pushing farther into dorsiflexion while FWB, without making me worry about your AT stretching too much. (PART of me misses the joy of those AT milestones flying by!! With luck, I’ll be flying by a new bunch starting in a month or so, post-heart-surgery!)
BTW, the “Post-ATR” time isn’t very meaningful, compared to the length of treatment. In your case, the two times are identical, but I wouldn’t encourage our pals here to measure time from the ATR itself. As long as treatment (surgery or immobilization) starts reasonably promptly, that’s when the meaningful clock starts ticking.
Parisski, this exchange has given me an idea, which I’ve just acted on(!). The UWO study only included patients whose ATRs were relatively “fresh” — within 2 weeks of treatment, as I recall. You started much faster than that, and I’d expect that to improve your odds, particularly with the non-op treatment you’re getting.
Essentially, the trauma of the surgery initiates an inflammatory/healing response in “op” patients, but “non-op” patients are surfing the wave of inflammatory/healing response that’s begun by the ATR itself. It seems logical to me that the best results would come from “catching the wave” while it’s freshest.
I’ve e-mailed Dr. Nick Mohtadi, one of the UWO co-authors, suggesting that SOMEBODY re-analyze the UWO-study data to test that hypothesis. I’m sure they’ve got the data, so it should be easy to get the answer, if anybody but me thinks it’s a good idea. They’ve already published another sub-study, where they analyzed the 25 non-op patients who had initial UltraSounds, to see if AT gap size or location predicted clinical success or not. (It did NOT — LARGE gaps ended up just as strong, as good a ROM, and as low a re-rupture rate, as SMALL ones, and in any position.)
Anyway, all I can do is plant the seed. But if it sprouts, and I’m right, we may see orthotic boots stored in gyms, right beside the de-fibrillator!
Parisski, congratulations on your milestone! You and I share the same date of injury, location of tear and non-op recovery & following Norms/UWO protocol, but I just went FWB this past Tuesday and there’s been no convo with my OS about going to two-shoes in the next 2 weeks. I’m hopeful soon, tho. Keep up all the good work:)
Hi Northrancher, thanks for your message! I spotted our identical date last week but was manic and no time to write. Was quite excited about going to two shoes tomorrow but am thinking of waiting a bit. I saw a friend last night who snapped his achilles 3 weeks before us (also waterskiing like me and up near the calf muscle - like both of us) and he tripped last week going up stairs and has re-ruptured his and is now having an operation on Tuesday where they need to use a toe ligament to create the bond between the tendon and the calf muscle. Am so sad for him and now very paranoid about going to two shoes myself (or going up stairs for that matter). I am very attached to my boot in which I feel so secure - I guess we all have to leave it behind at some stage. I am going to wait until i see the physio for my first session on Thursday. I had a joyous milestone on Saturday when I went for a 15 minute walk - it felt utterly brilliant to be outside in the cold air, without my crutches and just able to enjoy walking without worrying about slipping on leaves! Hope all keeps going well with your protocol and let’s stay in touch!
Parisski, isn’t it great to be out in the fresh air “walking” without those crutches!! I’m thrilled to be walking in my boot without crutches and have been all over the place this past week and weekend–out to lunch, a movie and shopping at the mall with my daughter. I even drove there, which is a “woohoo” experience after 6 weeks. I can “feel” when my foot/leg has had too much and promptly get home & out of the boot & elevate it. But, so far, so good…
I feel the same way you do about being cautious, especially after reaching this FWB milestone. The story of your friend and his re-rupture is a cautionary tale for all of us, I think. And, having surgery & borrowing a tendon from the toe…oh my. I really feel so sad for him. I wish him well. That’s my biggest fear.
I noticed your status is “two-shoes” now–are you out of the boot walking? I know we all heal differently, but I don’t think I’ll be out of this boot for another 2-3 weeks. You’ve made such great progress:) Like you, I’m really attached to my boot right now–I’m afraid to crutch even a short distance with the boot off;) I am not brave:)
Tonight, I’m attempting a shower without the boot, a scary proposition. My husband has offered to “spot” me for a bath, but our tub is way too deep and I don’t want to chance falling. I bought a shower mat and have a shower stool, so I should do okay. Have you been managing that already?
I’ve not had any physio sessions with a PT, but have been doing “light” exercising (thanks to a plan Bronny suggested). I’ll be interested to hear what you do in your session–that’s exciting!
Hope all continues to go well
Showering without the boot is scary at first, and only to be done CAREFULLY — but you both should be able to handle it at 6 weeks in, and it’s HUGELY better than the alternatives!
I have a stall shower, with a height-adjustable “phone” shower (which helps a LOT!). With the shower already set way down low, I leaned the crutches against the outside of the stall, boot-walked in, sat down, ditched the boot outside, closed the door, showered, squeegeed mostly dry, and crutch-walked out to another stool. (I kept a padded footstool by the bathroom sink, so I could sit or kneel while brushing teeth, etc.)
I also padded my in-shower stool, so I could kneel comfortably on it, as well as sitting. Switching between the two was always “interesting”, but not very scary. I only had to make about 2 crutch-steps to get from the shower to the outside stool — a good thing, because slipping on a wet bathroom floor on crutches would be Very Bad!
My crutches lived in the bathroom for the whole period from FWB to “wean off boot”!
My early-ish barefoot showering, as well as my early-ish barefoot sleeping, were both side-benefits of starting PT at 2 weeks — because I started doing both when my PT said it should be safe!
I have to tell you my shower story! When I got put into a cast I bought a plastic cover for it which arrived on day 5 post-ATR and I was very excited about finally having a proper wash. I asked my husband if he could find something solid for me to sit on in the shower and shortly afterwards he announced my shower was ready for me. I went upstairs (bottom-shuffling, obviously) and got ready for this momentous occasion. Looking in the shower I saw that he’d placed a plastic recycling box upside down in it and turned on the water so that it was nice and warm. I did all the scary stuff that Norm has described above, about very gently and tentaivley easing my way into the shower, and finally plonked myself down on the box. It was in that instance that I realised my darling husband had not actually thought to wash the box, which had been living outside in our garden and I was now sitting(swimming?) in the mud, earth and leaves that had accumulated over a lifetime in the outdoors. At least I was in the right place to get clean….:)
The upside down recycling box made me laugh! I bought ashower seat and it collapsed under me.