Stuck

Though I haven’t been cleared for nor advised to, I met with a PT gal today to discuss potential options for accelerating my recovery. She said my achilles looks great and that my range of motion is excellent…but she was unwilling to move forward without orders from my ortho at this stage. So…I am essentially stuck for now. Either I sit back and wait for my next ortho appointment March 15, at which time he may do nothing more than remove the 2nd heel insert and send me on my way, or I proceed alone. While this stage isn’t as bad as week 1, it truly does suck.

Oh yeah, the PT did also say to work the scar with vitamin E or aloe…not just for cosmetic purposes but to help with skin flexibility that I will need once I resume more normal activities.

19 Responses to “Stuck”

  1. You said your ortho said he was frustrated at your slow progress, right? Did you tell your PT that?

  2. So Sorry to hear this. Keep positive no matter what the word is on your PT. I know it isn’t easy…we ALL know it isn’t easy.

    I use vitamin E on the scar tissue and it has helped. I also use Peppermint oil for stiffness, and Wintergreen oil and sometimes Lemongrass oil to help relax the AT and calf muscle (was told to use these by a massage therapist).

    Good Luck.

    “Slow and Steady Wins THIS Race”.

  3. Norm,

    Exaclty the opposite. My ortho says everything looks great but won’t give me anything else to do to accelerate recovery. He just yanked one heel insert from the boot and said see you in a month. I met with a PT to see if she would help me keep moving forward in spite of doc’s orders. No go. Frustrating.

  4. Sorry, Pete, I just re-read your previous post, and I can’t see how I misunderstood that.

    You still have the choice about how to react, like your father or yourself so far. I ignored both my Orth AND my Physio when I went into a hinged boot at 7 weeks, and again when I stayed in it for a while after 8. Eight years ago, I wish I’d ignored my Physio when she told me to do as many single-leg heel raises as I could on the first day I could walk straight barefoot!

    On the other hand, your calf and AT will be getting some exercise every time you walk in the boot, which can be a lot — especially if you build up your other shoe so you don’t wreck the rest of your body from walking lopsided!

    (I just watched a little blurb between segments of the TV show House that said that the show’s star ,Hugh Laurie, is starting to have physical problems from limping with a cane when he’s in character. I can relate!!)

    If you feel comfy and safe taking out one more wedge, or one per week, I’d probably do it, but I’m me, not you. (What’s your Ortho going to do, have you put them back in on March 15??) But there’s also a natural tendency to succumb to wishful thinking and do too much too fast, and that tendency may “take off” once you start charting your own course. . .

    Good luck with whatever you decide. Me, I’m going to miss my second weekly Physio visit in a row, because of schedule conflicts, mostly as a result of some oral surgery that is bothering me WAY more than the AT this week! (I’m not sure the last couple of sessions have accomplished much, either, though I do plan to return next week.)

  5. Pete, I think it’s normal. My doc also removed first heel in one month’s time, actully he tried to remove 2, but my foot couldn’t reach that low. Seems like your doc has same schedule with mine. Also, Norm is experienced having ruptured his other tendon 8 years ago. However, if I could turn back time, I ‘d probably remove the heels, one per week too..
    Anyway, if your doc didn’t give you any options, I don’t think you should go ahead and decide by yourself. Just stick to your program, it’s another 20 days, no big deal, maybe you should try to remove 2 on your scheduled appointment and call it even. Ask him if he doesn’t tell you so.

  6. If I may ask, are you a left-handed person?

  7. Thanks Marina and Norm for the advice. And I am not left-handed, why do you ask? I may just do the accelerated insert removal plan…I still walk barefoot while at home, so fewer heel inserts in the boot can’t be that much different, although I am certainly more bold in the boot. I am currently on a business trip that had me walk through the entire airport to the very far end of the B concourse at DIA (denver) and though I am generally physically tired (since I haven’t done much in the past 5 weeks), my leg isn’t sore at all. I even slept without the boot last night since I was in a hotel with no potentially kicking wife. That is no great achievement, as I am allowed to do so…I just haven’t because how dumb would I feel if I re-ruptured it SLEEPING somehow?

  8. I’m just a bit scared of the possibility of rupturing my left tendon soon as I return to basketball. I’m right handed and just thought that this happened to my good leg because of its power /use.
    Well, go for it! As Norm says, doc won’t get you to a higher level if you do walk on a lower one.
    LOL! I don’t believe you can re-rupture it on your sleep. Soon as I wore the boot, I was sleeping barefoot with my husband next to me and was so relaxing! I was only wearing that boot if I needed to walk much.

  9. I thought I read somewhere that right handers pushed off with their left legs most often. Who knows. I will be just as paranoid about doing the other side no matter what.

    I have a theory I want to run by everyone, though I don’t think we have any foot doctors in the audience. Last year I put a stress fracture in my right foot. As part of the healing/treatment, the doc sent me to get orthotics. I never got them to feel good after 3 adjustments…but I did wear them in my normal walking shoes. I never wore them to exercise as it would have been extremely uncomfortable. So…the theory goes…since the orthotics have a somewhat raised heel, my tendon got used to being slightly shorter on average, and that contributed to my rupture when playing in basketball shoes without the orthotics. Seems plausible? I just need to decide whether to try to get those things adjusted so they are comfortable enough to wear all the time or scrap them altogether.

    On another subject, for those who built up their shoes to match the height of the “boot,” what materials wee used and where were they purchased? Walking the entire length of the airport last night and then out to my car was quite unpleasant.

  10. I used Dr. Scholl’s inserts to lift the heel in my non-injured shoe.

  11. First, about the orthotic: I play aggressive co-ed volleyball, and I bet that a bunch of the “babes” who play in that league also wear high-heeled shoes some of the time. They (or their ATs) should be dropping like flies if your theory is right. On the other hand, it does have some logic to it, so I’d give it a “maybe”.

    Some people here have had professionals fashion them an elevated shoe. One guy used to work for his Dad in a shoemaking shop, so he did a fancy job.

    I had a cheap “cast shoe” left over from 8 yrs ago, and I used it as the basis of my indoor “elevator shoe”. It’s a big flat sole with big nylon-canvas-and-Velcro “wings” to hold the sole of the shoe to your cast, or your foot, or whatever. There are many variations online, and probably at your local medical supply stores.

    It has lots of adjustability, so you can stuff lots of layers underneath your foot — commercial or home-made foot beds — and still be securely inside the “wings”. I actually took a cheap “flip-flop” I had hanging around (cheap Chinese “massage sandal”) and slipped it right into the “cast shoe”, and it matched the height of my walking boot. Your mileage may vary, but be creative!

    For outdoors, I found that I had some Merrill-type low boots with quite thick soles, and I just put in as many commercial footbeds as I could squeeze in, and it came close enough. Matching the angles (heel lifts) makes sense, too, as ultidad suggests.

    And Pete, the things I DO know about “handedness” and ATRs are as follows: (1) Left ATRs are much more common than right ones. (2) Right-handers are much more common than “southpaws”. (3) Most people are “opposite footed”, so most right-handers are “left footed”.

    From this, I’ve concluded that it’s ALMOST CERTAINLY true that it’s more common to tear your “dominant-foot” ATR than the other one — although I’m left-footed and I tore my right ATR first (8 yrs before the left). And it seems at least LOGICAL that those of us who tore the “wrong” AT first may be at higher risk of tearing the “right” one later, as I eventually did.

    BTW, the standard test for “footedness” is this: If you were running on a slippery surface like an ice-skating rink, and you wanted to do a long slide, which foot would you put forward?

    Last thing, especially for Pete: Not far from here (in Toronto Canada), we’ve just discovered that one surgeon managed to remove NON-cancerous breasts from at least two different women. Since that news surfaced, a third woman has also surfaced, and on the radio today, I heard her story about how that surgeon ALMOST bullied her into having that surgery, too. But the patient was mature enough and strong-willed enough to insist on her right to a medical second opinion, which said that she was cancer-free and needed no surgery. (I think I also heard one of the “victims” telling the story of how effectively she was talked into the surgery, despite her objections.)

    These are not Gods, people! (Heck, they’re not “rocket scientists” or “nuclear scientists”, either, and we all know that both of THOSE groups can be colossally wrong, too!)

    They are trained human professionals, with good days and bad days and mostly BUSY days, and they are working for YOU, the patient! There are many areas of medicine (I used to think Cancer was one of them!) where you’ll be treated by a team of professionals that should know LOTS more than you, or your brother-in-law, or me, or maybe even the collective wisdom on some patients’ blog.

    But I don’t think ATRs and their treatment is one of those areas! Heck, virtually nobody ever dies from an ATR, or ATR surgery, or from not getting ATR surgery. And most patients eventually walk OK again, at least well enough that they don’t sue their doctor for big bucks. So it’s really easy for each doctor, each physio, each hospital and even each region of the world, to keep doing what they did 10 years ago, regardless of the evidence.

    These are not published scholars defending their latest peer-reviewed papers in conferences, folks, they are clinical doctors and physios, with a full schedule of patients to see every day! Most clinical doctors probably learn more than half of “what’s new” from drug company reps who stop by to sell them something (and wine them and dine them and leave them with samples and other gifts). Heck, the biggest cause of needless death in most hospitals these days is bad hygiene — fancy surgeons who don’t bother scrubbing in properly, or professionals who don’t change gloves at the right time! (Rocket science? Puh-leese!!)

    In honor of the two local women who got their non-cancerous breasts removed, CBC Radio did a phone-in on “getting a second opinion”, and it was truly an eye-opener.

    That doesn’t mean that all professionals are clowns, or to be ignored, of course. But if you present your professionals with some Evidence-Based Medicine that indicates that there’s a better way, and they respond with “Eminence-Based Medicine”, by dismissing you because you’re not an MD. . . well, then you’ve obviously got a clown for a professional, IMHO — at least in that case on that day!

  12. All fair observations, norm. What I battle against is the risk of re-reputure and going through this again. I will find the right balance eventually. I just seem to have more time to think about it these days. My doc is extremely competent and had fixed many people very well (I met one at my daughter’s basketball game). I am in good hands but impatient because everything feels like a go.

    Thanks for the advice on the shoes. Come to think of it, I do have a medical clopper shoe they gave me for my stress fracture last year which could be a perfect indoor shoe (though I am most often barefoot at home). Outside, Ron, my orthotic makes my running shoe pretty high, but not equal. I doubt I could get another insert in over the orthotic. Maybe a craft store has some extra material…that isn’t slippery. I can’t believe I just hit 6 weeks…time does keep going by, which is a good thing.

  13. My hinged boot has a rounded smooth rubber sole that is totally useless in snow or ice. My initial AirCast boot had nice deep ridges on its sole, but I always wrapped it in a plastic bag (it was spending every night in bed with me!) which turned it into a slippery thing. I think those “cast shoes” are available for around $20 or less, so maybe you could have one for indoor and one for out? Or stay barefoot at home and use the “clopper” outside, if it isn’t too slippery? Or maybe you could cut grooves into the sole to make it ridged.

    I’m glad you have a Doc you have faith in, though that doesn’t resolve your frustration, or the apparent contradiction between your walking barefoot and having a massive heel lift in your boot. This Too Shall Pass. . .

    Re-rupture is obviously the worst of the likely outcomes, no argument there. I sometimes think of this rehab like a shot in tennis or volleyball, where you SORT OF aim to hit the line. But you really have to leave a cushion, because hitting OUT is way worse than hitting a shot that’s a little too far in. . .

    My first ATR rehab seemed “silly slow” to me at the time, and it’s even slower by today’s standards. But I DIDN’T injure myself from an extra month (or more) of crutching, and that AT has been solid ever since. So “slow and steady” does seem to work OK in most cases. (But jumping from barefoot to a boot in equinus still seems nuts to me, sorry!)

  14. Hi Peteco

    I’m 37 days post op, 39 days ATR. Cast off 34 days post op, now in Aircast boot, 1 heel wedge. Am walking around house FWB, without boot or crutches, albeit with limp until I get more ROM. Am fairly close, but don’t want to stress the AT to get more dorsiflexion just yet. Keeping most weight on the heel. Using Aircast (no crutches) to protect AT when outside.

    I live in Boston, with plenty of ice and snow, so after a slip/fall, strapped on old Bledsoe Boot over my cast, so was PWB ( 1 crutch on opposite side) at 2 days post op. Had 4 heel wedges so could keep all weight on heel, toes in equine position, so not tensioning AT at all.

    I felt that PWB with Bledsoe Boot was safer. I also saw some research that showed that most re-ruptures occured from a fall.

    I also had no pain nor swelling. My doc did a great job staying away from nerves, etc. and I had locked up the ankle pre-op with the Bledsoe Boot so there was a minimal incision and no swelling.

    Was walking my dog on the beach 6 days post op when my surgeon saw me standing - cast, Bledsoe Boot, 1 crutch. We let our dogs play, and chatted for about 20 min.

    Because I have using the leg actively there has been little atrophy, therefore limited swelling and pain. I have to stand at work, so knew from previous ankle surgery (right foot - fractured medial malleolus, ruptured posterior tibial tendon) 11 years ago that atrophy leads to bad things such as swelling and possibility of DVT while standing for a very long time.

    Starting PT next Weds - will be 41 days post op.

    Regarding the heel inserts. I think that soft, commercial heel inserts may overstress the AT when they soften more with use. The tendon shortens in normal use, but the soft insert compresses more when we are active, thereby putting a greater stress on the AT. If I use heel inserts now, I use fairly hard rubber ones. I also make my own by cutting the hard insoles you find inside your shoes. Or I use the hard rubber ones that came with the Bledsoe Boot.

    Though this seems to be working for me, everyone is different. Just letting you know my experiences.

  15. Hi Lou,

    Yet another variation on recovery protocol with your story. I never had a cast and got the boot after my surgery splint at day 10 PWB and 2 days later was FWB, doc’s orders. Seemed aggressive at the time by my doc, but I have never had any pain. That is why I am frustrated at 6 weeks now with no PT prescribed, when I have been FWB in and out of the boot for over a month. Seems I could be doing more, but apparently every doc has his method. And my doc is not supportive of me walking around outside the cast at this time. Just strange all the permutations in treatment. Hopefully we all arrive at 100%, regardless of how we get there.

  16. Lou, was your original cast a fiberglass “walking cast”? When I was getting the cast treatment (post-op, 8 years ago), my first cast was a plaster-of-Paris thing that wasn’t designed for weight bearing (AFAIK).

    Interesting thought, to keep the heel of your injured (and repaired) foot WB immediately after surgery. Especially interesting since a lot of us — even those on relatively quick rehab schedules, like me — have found it challenging to re-introduce our heels to the “pleasure” of WB. (Even after 6 weeks of FWB, my “bad” heel can’t stand on a rough surface, like dimpled “massage sandals” — and it’s just barely OK on bare floors.)

    It’s also interesting that you say you’ve completely escaped swelling. THAT I’ve never heard before, in this crowd. Even those of us who weren’t sliced open AT ALL have experienced the joy of elevating our “bad” feet, and the discomfort of leaving it/them below us for long. So that aspect seems amazing, maybe even miraculous, no matter how good and careful your surgeon was.

    Finally, I can see how your approach would eliminate atrophy in your knee and thigh muscles — but you’re still not using your calf muscle to pull on your AT, so it’s bound to be atrophying this whole time, isn’t it? If you’ve got a secret to avoid that, please share! (At 11 weeks post-immobilization, I’m still working to get my strength up enough to “push off” at the end of a normal stride, instead of “dipping” a bit after I roll over my “bad” foot.)

  17. Hi All

    To Norm,

    Yes the calf muscle is slightly atrophied, but does not compare to the atrophy I had 11 years ago when I did in my right ankle, and went 10 weeks NWB. The rest of the leg muscles are doing their job, pumping the blood out of my leg and back up into my body, limiting swelling.

    When in the cast, I did toe exercises such as toe lifts and circles to keep the other muscles toned. When I did in the right ankle 11 yrs ago, I lost 15 pounds of leg muscle and had lots of pain from the swelling, even after only 20 minutes of standing (I teach). This time, a fraction of that muscle loss - and just the calf muscle. I taught classes the Thursday after surgery.

    I had a fiberglass cast - not a walking cast. It was equine and I had the 4 - 10 degree wedges from Bledsoe Boot for the right ankle, and adapted the Beldsoe Boot to take the shape for this new cast. In effect converted the cast into a walking boot. The trick is to make sure that you do not tension the AT during the PWB/FWB, by maintaining equinine.

    To Pete:

    My surgeon gave me this guide to recovery:
    http://achillesblog.com/files/2008/03/achilles_tendon_rupture_mass_gen.pdf

    I do not have the details of your rupture, as your doctor does. But if you are not in pain, and unless the doctor tells you of a complication that you are not aware of, then you might ask why not start something as simple, and non-threatening as the phase 1 exercises.

    I understand your doc not wanting you to go outside without the boot. It’s to protect your AT if you should fall.
    I put on the boot on when leaving the house, and am very careful when walking without the boot inside. I wear a pair of sandals with non-slip bottoms. I’m afraid shoes at this point might irritate the incision. In fact, I may go back to the Bledsoe Boot, as it does a much better job of locking my foot, ankle, and leg than my new Aircast boot. I find my incision is sensitive after being in the Aircast for too long. The Bledsoe boot has 6 straps, versus the 3 for the Aircast, so I’m able to adjust the pressure on the incision site much better.

    I went through the heel sensitivity that Norm describes with my past right ankle recovery. I think that will resolve with muscle buildup around the heel - you lost mass there while NWB also. By going PWB so soon after surgery, my heel never lost its muscle mass. I was putting weight on the heel 2 days after surgery.

    The swelling and pain you have now is probably the result of the muscle atrophy, and blood settling in your leg. I don’t think it will not go away until you rebuild the lost muscle mass. Until that time, I suggest taking that aspirin a day. ATR are bad, but not life-threatening. DVT’s are.

  18. Lou, a lot of the info in that Mass. General guide to ATRs is sensible, but almost every sentence on the second page has been disproved by the FOUR most recent randomized trials (linked on my blog)! But these myths keep being re-circulated and reprinted and repeated, as if they had something going for them!

    All the statements about superior strength and ROM and lower re-rupture rates from conventional surgery vs. non-surgical immobilization have been proven just plain wrong. Oft-repeated myths.

    Now I think I understand why they Mass. General registered the PDF file so it’s impossible to copy-and-paste quotations from it — too embarrassing! ;-)

    A lot of the protocol also seems slower than the recent studies have proven effective (after surgery or non-surg), exposing the patient to unnecessary risk of falling while on crutches, not to mention the inconvenience.

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