11 Comments so far

1. eva10 on October 29, 2013 11:39 am

   PWB to FWB - At the start of week 5 I just tried stand up without crutches. Once I could establish that I could stand without the assistance of crutches I did a forward shuffle until I generated the confidence to walk in my boot without the aid of crutches.

   FWB to 2 Shoes - After 6 weeks my Ortho said it was time to start walking in 2 shoes. It took me about 20 min of stretching my foot to get it used to sitting flat on the floor with weight. I had been in a boot with a 2″ heel lift for 4 weeks at this point. I used crutches for about 30min to ease the amount of weight I was applying when I was walking. After that I was off to the races…well not quite. I would walk quite gingerly for the first couple of weeks focusing on pushing off and ensuring I was moving with proper form. Make a conscious effort to walk correctly and you should see yourself recovering rapidly.

   Good luck!

2. jdotjones85 on October 29, 2013 3:31 pm

   Hey Ron,

   I will start PT tomorrow. It’s actually my 9th week (I calculated incorrectly) and I plan on asking those questions. I’m unready (at least mentally) to begin FWB without crutches. I’ll let you know what tips I can dig out of my ortho and what to expect from my PT.

3. Ron on October 30, 2013 12:48 am

   Thanks Eva10,

   So, there was no pain? What did you do to ensure that you had enough Dorsiflexion and muscle calf? Does that make sense?

   I’m afraid that I will either fall, have severe pain or re-rupture.

   Thanks and good luck,
   Ron

4. Ron on October 30, 2013 12:51 am

   Hi Jdotjones85,

   I feel ya, 100% LOL. Seems like forever when I walked normally.

   That’s why I put this post up, but hopefully it will yield the microscopic baby steps that we need.

   I have my first PT appt. next Friday, but would love to be ahead of the curve.

   Thanks, good luck, and keep me posted.
   Ron

5. Ron on October 30, 2013 12:53 am

   I had to put Norm’s reply to me regarding “2 Shoes” when I asked him on another blog post. It was very well thought out. Thanks Norm.

   “…Some people recommend heel wedges when going to 2 shoes; I generally don’t, because bit.ly/UWOProtocol didn’t, but it’s probably no big deal.

   Either way, the challenge when you’re first in 2 shoes is that your calf-and-AT are still weak and vulnerable, and your DF ROM may also be limited. But with or w/o DF ROM, you can’t USE that ROM while walking (the way you normally would) because you don’t have the calf-and-AT strength to hold yourself up when you stride ahead of your healing foot. You’d fall if you try, and trying would hurt, and might even cause a rerupture, so it’s a total No Go.

   So when you’re walking-standing on your injured foot and moving the other foot forward, you can’t move it far before you’ve gone too far. For your first steps, you may just bring your “good” foot up to your healing foot — or maybe not even. Planting your injured foot way ahead of you and catching up to it isn’t a big problem, but doing the mirror image is.

   So: some people take the “walk normally” advice even farther than I do and recommend a short-strided, slow, symmetrical gait. I.e., don’t do anything on one side that you can’t do on the other side. I don’t see any advantage to going THAT slowly, and I don’t think anybody is going to make a habit out of walking with one short stride and one long one.

   So: I recommend taking one stride as normally as possible (when you’re striding “over” your “good” foot, injured foot forward), and shortening your other stride as much as you have to, to keep your injured foot safe. You’ll get around MUCH faster that way, and I haven’t heard from anybody who’s been harmed by that asymmetrical (but otherwise normal) walking. Again, avoid NON-normal walking, like sticking your toes out to the side and rolling over the inside of your foot, because that CAN cause harm. And it’s not on “the path back to normal”, either.”

6. craiger9er on October 30, 2013 12:44 pm

   I second what Norm said. When I started, my goal was just to bend my toes and bring my heel off the ground, not necessarily push off and get the correct gait. I didn’t put my good foot too far out in front of my ATR foot because I didn’t want to bend the ankle too far and do anything to the Achilles.

   I also paid a LOT of attention to what my good foot was doing and tried to emulate it as much as I could with my ATR side. From hitting the heel right, to rolling the foot to walking with my feet pointed as straight as possible and really work on a normal gait. You’ll have to “re-learn” to walk,so try to do it as correctly as you can. I was afraid that if I took shortcuts and didn’t do it right, I’d have to re-learn again.

7. normofthenorth on October 30, 2013 1:53 pm

   Ya, we’ve had a few people here during my time (~3.5y now!?!) who’ve had to re-learn their gait. Sometimes they know they’re still walking wrong, sometimes they don’t know ’til a PT or other health pro tells them and starts fixing it. Best to keep everything but the stride length and the final “push-off” as normal as possible — and keep your hips level too, by raising your good foot to match your booted (or heel-lifted-in-shoes) foot.

8. Tord Steiro on November 4, 2013 5:39 pm

   I tried PWB with the cast, primarily through excercise on a rowing machine, placing my heel on the foot board and pushing lightly.

   After removing the cast (17 days postop) and using an orthosis, I gradually increased weightbearing and reduced the use of crutches. This got tricky, as I was alone with my 15 month old boy for a certain amount of hours every day. Sometimes you just don’t have the opportunity to grab for the crutches before moving… So I guess I introduced occasions of FWB a bit too early, whicb isn’t a good idea. Nor does it feels good - rather the opposite.

   As my range of movement improved, the orthosis were adjusted accordingly, and I increased weightbearing. My first intended try at FWB was with a 100 degree angle on the orthosis, placing my heel on the threshold, securing my balance with my hands grabbing the doorframe. Standing in this position became a regular ‘excercise’ for some time.

   A second activity was to rush up a long hill with crutches and no weight-bearing(some ten minutes - a real workout for your upper body!) and then walk down with three-four steps without crutches, followed by some three-four steps with crutches and PWB. The advantage of walking downhill is that you can have a decent stride even when your foot is locked in the orthosis.

   As I reached 90 degree angle in the orthosis, I was walking without crutches. In this period I was walking a lot - strolling the boy to kindergarden, walking to the fysio, walking to the store, walking to the gym. I think I walked more than 100 miles the first two weeks after I scrapped the crutches for good.

   Gradually, I used the othosis less, and two shoes more. I used the orthosis far longer than my physician recommended, over ten weeks compared to the recommended five, but I figured that the sheer amount of walking, over 50 miles a week, demanded that I use the orthosis for at least half of my walking needs.

   As I regained enough flexion and strength to drive, the distance I walked every day obviously went down, and I stopped using the orthosis alltogether, walking with two shoes.

   As my tendon was still somewhat painful, and I had only limited strength and flexion, I modified a pair of jogging shoes. i.e. cut off almost an inch of fabric off the heel cap, and raised the heel with an extra sole. I walked with this for a couple of months.

   5 months on, perhaps due to all the walking, I can now stand some 10 seconds on my injured foot alone, with my heel raised some two inches from the floor My balance in this postition isn’t great, but it’s getting better! I can also run quite OK, doing 200m/40sec intervals. I also ran some 9 miles in a bit over an hour the other day.

   Not exactly fit for any competition, but not bad either, considering the nature of the injury.

   At this stage, I would actually recommend running with some pace, or slowly uphill, to any other excercise. I still get ankle pain and swelling from walking and slow jogging. But running, either slowly uphill or faster on flat, seems to reduce both pains and swelling.

   Surprisingly, if I have pain and swelling in my ankle due to excess walking or jogging, a set of 200m intervals appears to reduce both. The same goes for uphill intervals.

   I suspect that this has something to do with muscle atrophy in the ankle itself, in combination with my stride. That faster running translates into a better stride, that again reduces impact in the ankle - to the talus in particular.

9. Tord Steiro on November 4, 2013 5:44 pm

   I almost forgot one important thing:

   My first steps were taken in a swimming pool. Swimming pools are highly recommended for rehab, and I wish I would have been able to use that much more! You can do so much in a pool, and the pressure will reduce the swelling.

   For future exercise, I will also recommend using a skipping rope. Keep one in your office, and aim to behave like an i******* once every hour

   Good luck!

10. Ron on November 4, 2013 6:46 pm

    Hi Tord,

    Thanks for your input and great comments.

    Wishing you the best in your recovery.
    Have a great week.
    Ron

11. Ron on November 14, 2013 10:10 pm

    Thanks everyone for the advice on moving to 2 shoes.

    It was great stuff, and now I am not only in 2 shoes, but driving as well!!!!

    Norm, giving my the concept was awesome. I understood from your description of what it would entail (DF, muscles needed, etc.).

    Thanks again, and good luck to everyone.
    Ron