pete0609’s AchillesBlog






         Just another AchillesBlog

May 5, 2014

Six week update and Connected!

Filed under: Uncategorized — pete0609 @ 8:56 pm

After a very disappointing meeting with the surgeon in the hospital (it lasted 90 seconds, he didn’t even look at my foot and gave some strange recommendations that weren’t even in line with his own uwoprotocol - i am not going back there, just a waste) i saw my sports doctor today and that was helpful.

I am at six weeks post rupture (non-op) and my sports doctor felt my tendon, said he could feel it’s connected again and where the injury was he said he could not feel a dent or divot. I guess that’s good, but probably normal at this stage. I’ve never had much of a swelling, rarely iced it, but always took my foot out of the boot and put it up whenever i couldĀ (and did the ROM exercises).

Like probably most people I have this lump around the injury and he told me to massage it. Use some oil to not break the skin, but to somehow loosen the scar tissue, and massage it hard with your thumbs. Kinda hurt when he did it, but the doctor said it’s necessary to break down the scar tissue so the tendon can move better.

He also really wants me to get going and move around, ratchet down the angle of the vacocast a notch or two every 3-4 days. I should be at 0 in two weeks, then take off the rocker achilles sole and put on the flat sole, then and start hinging. Then transition into two shoes. He said to do what i can tolerate. If am sore for an hour or maybe two after changing the angle, that’s fine. If i am sore for longer than that, it was probably too much, so i should listen to my body and see what i can handle. His important message was to get the tendon somehow to move and stretch, but not too much.

I also started doing very gentle seated heel raises. Unbelievable how difficult this has become.

11 Comments »

  1. Make the angle changes at bedtime, to let your AT & calf stretch overnight before you load it up. If it feels like too much stretch, it might be. If it feels like “at LAST!”, it’s probably overdue. But stay close to the most successful protocols - though the angle progression to neutral is the least consistent aspect of the new successful protocols.

    Comment by normofthenorth — May 6, 2014 @ 1:17 pm

  2. Hi Pete, I think we are about the same on our recoveries. I did mine on March 19th and am non op as well. I have my vacocast set at 2.5 on hinged and was told to move mine down gradually as well. Supposed to listen to my body I guess. This is the scary part cause not really sure how much to reduce every week. Doctor said I will be at 10 degrees when I go back on May 28th for 10 week check. Good luck on your recovery and let me know how it progresses.

    Comment by Brad — May 7, 2014 @ 9:34 am

  3. Brad

    You should refer back to Texasflyer’s blog and re-read the Exeter protocol which I addressed to you a few days ago and which included boot adjustment in degrees.

    It’s not always great to listen to your body either. If it is screaming ’stop’, then stop, but much of the time you will need to gradually coax it along, persuade it that it really can do that little bit more, that it has now been proven by thousands of other ‘victims’ that slower is not better. TOO fast is bad too of course but there are guidelines aplenty in these pages.

    The main problem that I see is that you are on a slower schedule and might need to adjust your time increments - but at least it will give you some idea of how much to adjust and how long for.

    Comment by hillie — May 7, 2014 @ 10:50 am

  4. Thanks Hille, I will print that out and show to my doctor.

    Comment by Brad — May 7, 2014 @ 11:07 am

  5. Brad

    For even more credibility you might want to print off the Exeter report abstract mentioned in my post. This names the specialists and your guys can contact them direct if they wish to. Just think - sharing experiences across the pond - revolutionary!!

    www bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_18/16.abstract

    Comment by hillie — May 7, 2014 @ 11:34 am

  6. Hi Brad and Hillie,

    Thank you for your comments. I am following uwoprotocol and my boot is currently at 15 degrees non-hinging in the vacocast. I am using this boot because of better fit and better support to maintain a somewhat normal gait. With my doctor I agreed to be at 0 degrees after week 8 (for me that would be end of next week) and start hinging once I start weaning off the boot and into 2 shoes ( after week 8). Norm had some comments about the hinging part and there might be some risk to it. I know that the Exeter protocol is more aggressive, but uwoprotocol also got some pretty good results and I hope I am okay where I am.

    Comment by pete0609 — May 7, 2014 @ 7:39 pm

  7. Its scarey every time I lower it. I’m about to go down from 20 degrees to 10 degrees at the end of week 7. And then I’m going to try for 10 to 0 a week later at the end of week 8. When I went from 30 to 20 it was so tight I almost went back to NWB for that day because it got so sensitive.

    Comment by Roark — May 8, 2014 @ 12:54 pm

  8. Are you sleeping on the angle changes overnight before adding any weight? Are there any halfway gradations on the Vaco? I’m usually all for speed, but adding a few days may help here.

    Comment by normofthenorth — May 8, 2014 @ 1:47 pm

  9. With the vacocast you can do 5 degrees at a time, so from 20 to 15 and 10 to 5 is possible. That’s what I do. However, I sleep in the aircast boot (for some reason I find it more comfortable to sleep in)’, while I wear the vacocast during the day. To align the two is not really possible, because the aircast has only four wedges (I measured the full wedge, it’s about 30 degrees). I might also not take out the last wedge on the aircast, because looking at it it seems the heel would be lower than the ball of your foot if you did that.

    Comment by pete0609 — May 9, 2014 @ 9:33 pm

  10. Thanks, Pete. But I think you’re measuring the angle that the wedge forms all by itself, and that’s not the key angle. The key is the angle the wedge gives to your ankle. I believe the trig is basically from the fattest part of the wedge (the part right under the ankle’s fulcrum should be the key) down to zero at the ball of your foot (not the front of the wedge). I keep hearing that a 1-cm wedge translates to around 10 degrees, though my trig came out a bit different. But 4 30-degree wedges combined would be 120 degrees below neutral — toes pointing 30 degrees BEHIND you when your leg is vertical(!), which certainly can’t be right.
    My ankle was in neutral in my Aircast with no wedges. If you think yours is lower by a drug-store heel wedge, I don’t think you’d be doing any violence to add one. And similarly, if a thin wedge helps you get the ankle angle the same in your two boots. . .
    PTs use protractors to measure ankle angle, but you could easily make a jig out of two $-store rulers and a nut and bolt — drill a hole in the rulers, connect them with the nut and bolt, then measure the angle with a real protractor (or with trig). I’m sure you could add a $-store protractor bolted into it, too. . . Alternatively, most post-ATR legs are pretty good at deteccting and measuring tiny changes in boot angle!

    Comment by normofthenorth — May 10, 2014 @ 12:40 am

  11. Hi Norm, sorry I got that wrong. It’ s only one wedge that consists of four elements/layers. so far I’ve taken out two, so the wedge of the aircast is now at half the height (under heel) it was - which should be 15 degrees. However, it feels quite a bit different to the 15 degrees of the vacocast - lower if you ask me. It might have to do with the fact that the wedge is now shorter in length than it was (it went from heel to almost toes in the aircast). At the front of the aircast, where the toes are, there is some Velcro that builds up a bit and it seems to give the front of the foot a little bit of a lift. Anyway, tonight I’m going to take out one more layer/ element of the aircast wedge (of the initial four) and bring down the vacocast one more notch to 10 degrees.

    Comment by pete0609 — May 10, 2014 @ 4:52 am

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