Not nearly as aggressive as I had hoped

Rash still there...wound looking good.

Rash still there...wound looking good.

So I just saw the ortho who did my surgery exactly a month ago, Jan 15. I was excited, thinking that I would be on to something new and different; maybe some additional stretching/strengthening exercises, permission to go 2 shoes full time, etc… Turns out I was getting ahead of myself in a big way.

The doc came in, looked at the wound, and said everything looked great. He said I should start to massage the scar (not the achilles) to help make it stronger and more pliable. OK, no worries, I can do that. I just won’t mess with the achilles based on the experience of Gerry on this site.

The doc next did a brief test of my strength by holding my foot and asking me to push down. He was pleased with that test and then asked me to tense my calf by pushing on his hand while feeling my calf. He seemed satisfied with that, saying the muscle was “firing” well. He insisted that I continue to push down against my boot to continue minimizing calf atrophy. Fine, no problem.

Then came the depressing part. I admitted to him that I have been walking around without the boot for 2 weeks. He was not pleased. He said I was not to do that at all, citing the risk of re-rupture. I told him it wasn’t like I have been rolling over the ankle and pushing off hard, but that made no difference. In his mind, the risk of walking barefoot or in two shoes, both of which I can do no problem, is not one I am allowed to take at this point. I told him that I had heard (reading on this site) that the tendon is basically indestructible at 6 weeks - so could I resume walking without the boot then (in 2 weeks)? No way, he said…and countered that the tendon was perhaps at its most vulnerable around 6 weeks. Odd.

So what CAN I do? Well, for starters, he removed one of the heel inserts from my boot, so I am down to two (I can barely tell the difference except that my gait is less lopsided - walking barefoot is much flatter than 2 inserts). He said I could bike or swim, but only for general fitness, not for achilles strengthening (keep foot at a down angle on bike). Whoop de doo! I mean, I am glad I can do those things, but without moving the ball forward on the injury, I am not terribly excited.

Then came the crushing blow…I don’t see him again for a month! I asked what would happen then. He said he would take out another heel insert and I would be that way for another 2 weeks. Then, if all went well, no insert and start on shoes. So his program, while it began with FWB at 10 days post-op, it doesn’t officially move to “2 shoes” until at least week 10. I know I can’t complain too much as some folks are in casts until then NWB, but I had really hoped for so much more. If I were my father, I would completely ignore what the doc had to say and plot my own course. But…I will do my best to follow his instructions, although I can’t see completely throwing away the convenience of walking around the house barefoot.

At the end of the day, I am pretty bummed about this visit…and I am still dealing with this stupid rash, which just won’t go away…see pic above. On the positive side, he said I could sleep without the boot if I wanted…so I will end on that note.

7 Responses to “Not nearly as aggressive as I had hoped”

  1. Peteco,
    Sorry to hear it didn’t go as well as you had hoped. I’m 5 days behind you (Surgery on 1/20) and am now FWB for 3-4 days or so. I’ve been sleeping w/out the boot for weeks now. Never tried to walk without the boot, just not comfortable to even try it yet.

    As I’ve read your posts, I’ve been inspired by your progress. You seem to be way ahead of schedule, despite this apparent setback.

    I’ll be eager to read about your progress over the coming months, as it seems I’m not too far behind. I go back to my doc on 2/25 and I’d expect him to give the ok to start PT, but boot to remain on until mid March. In the meantime, I’m forced to take it easy and slowly walk around without the crutches doing the simple home exercises.

    I’ll post the progress report on my blog.

    Hang in there.
    Dan

  2. Dan,

    I fully realize that I have no right to whine here…besides the stupid rash, I am technically doing just fine. I walked in sandals outside tonight to grill steaks, so my quality of life is pretty good all things considered. I no longer pee in a bucket at night…I get up and hit the bathroom…all good stuff. I was just taken aback that he didn’t want me doing anything outside the boot. I have to travel for work next week and was hoping to go in 2 shoes and not the boot. Perhaps I will get more sympathy in the boot. I will go with the program and cautiously attempt to overachieve from time to time. For now I will focus on getting rid of this stupid rash and go from there. Thanks for your well wishes and I will give updates from time to time. Best to you in your recovery and let me know what your doc has you do at the next appointment.

  3. Several people here have ignored their surgeons, and others have discussed switching doctors for faster rehab — though I’m not sure if anybody’s actually done that. The patient is supposed to be the boss, after all.

    And many of us have had ongoing arguments with our surgeons, trying to counter traditional “conservatism” with evidence-based arguments for relatively quick transition to WB and physio and ROM, etc. For my first ATR, 8 yrs ago, I ultimately let my doc win all the arguments, though I was the first ATR patient he ever put into a hinged boot instead of one more cast. (And I think the hinged boot is a great invention!)

    Yours is also probably right about the risks of re-rupture being high at around 6 weeks, since most ATR patients are safely in a cast until around then, without much chance to re-tear the thing. Now that I’m padding around in 2 shoes most of the time, I’m sure I’m at much higher risk than I was in the boot — despite my much stronger tissues now. That doesn’t prove that early 2-shoes is a “bad bargain”, but it is a tradeoff. Muscle atrophy and a slow “tail” to your rehab isn’t your doc’s problem, but a re-rupture is, so some conflict is natural.

    Many people have removed heel-lift wedges a lot faster than your surgeon is planning, as you know. My protocol (w/o surgery) left mine in for 6 weeks, then straight out (though I tapered off for a few days).

    If you are going to stay in the boot, with heel lifts, I’d strongly recommend building up a shoe for your other foot that’s comparably high (and maybe comparably heel-lifted, too. Symmetry REALLY helps keep our bodies aligned, and walking straight, etc. (I’ve outlined how I did it on my blog.)

    Good luck, whatever you decide!

  4. When my surgeon put me on the boot, was near Christmas and he gave me an appointment appx 25 days later to remove a heel (still on crutches back then). When I saw him, he told me to remove 2 heels instead of one, but that felt impossible. So I only removed one and stayed like this for 2 weeks. Soon as I removed the second heel, I started PT. Your doc seems to act like mine, and even if I think he’s a bit conservative, I tend to like this now. I’m pretty impatient normally, but I totally sticked to his instructions and here I am walking now. Since I play basketball for 21 years now, I knew some kind of things about injuries, but never ever occured a ruptured tendon to none of my teammates all these years. So I knew nothing. Then I found this site and I learned A LOT, but still, that doesn’t make me a doctor.
    I also know that surgeons operate. Soon as they realize that their operation is going well, they kind of ‘leave’ you (don’t see this the wrong way) and then it’s the physio’s job to actually make your foot look and act like a normal one. My doc suggested 15 PTs but I’m going for much more.
    Also, that ‘build up a shoe for your good foot’ thing that norm has mentioned is pretty important. I didn’t do it and got some back massages on my spine for not sitting and walking straight..

  5. I am pretty sure I could take out all the wedges right now given that I walk barefoot often, but I will stick with the program for the boot. Even taking out the first wedge helps a lot in terms of lopsidedness when wearing the other shoe. It has also made the boot seem quite loose down there. I wonder if that is by design to allow for more movement or if I should clamp it down harder. I can definitely walk faster with one wedge gone. I think I would feel better with PT, but I haven’t seen many on the site get that at week 4.

  6. Remember..”Slow and Steady Wins THIS Race”.

    I want to be back to my normal life too…but I’m making myself take it as slow as my PT and Doctor want. I have a full life ahead of me and I don’t want to screw it up because I WANT to move faster.

    Good Luck!!

  7. Hard to answer the question about making your boot snug with a wedge out, Peteco, because it all depends on how much you want to do what your Doc says. The whole idea of the fixed boot is to control and contain and immobilize the ankle, like a cast.

    On the other hand, if you really want to be in shoes, then a loose boot is closer than a tight boot. You seem to be turning into your own Chief Health Advocate, and you have to decide whether or not you’re going to stick with your Doc’s advice, or how far to stray, or whether to even shop around for a Doc whose protocol and approach you like better.

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