Mixed Feelings
16/10/2010
went to visit the Doctor yesterday and got the cast off .
Thank you !!!!! Thought Id never get rid of it .
Anyway before he took it off he looked at his file on me and told me what was going to happen over the next 8 weeks , this was without looking at the leg and see how it was progressing .
Is this “the norm” ?
Basically he took the cast off and told me put no weight on it for 2 weeks , then 1cm inside my shoe 1 cm outside the shoe for 2 weeks , then ½ cm inside and ½ outside for two weeks …….
After these six weeks I have returned to see him and also get a heel lift ……..
I had also to start with a PT in 2 weeks .
Despite never wanting to loose something more in my life ,
I couldn’t believe it , after the most serious injury I had ever had and probably the worse 6 weeks of my life he was sending me home with NO protection (booT)on it and I panicked.
I mentioned various protocols and things I had read here and he said it was because I hadn’t had the op for a month after the ATR that mine was going to be longer .
As I had a cast off for the first time in 6 weeks even while I was in his office I was very nervous about damaging my AT so the thought of having to be so carefully with it for 2 full weeks scared me .
I told him this and he said if I want I could get an aircast boot with the 2cm inside it but I still couldn’t put weight on it for the 2 weeks mentioned …….and follow the above 6 weeks in the boot .
As I was in there hearing the weeks next 8 weeks made me panic and I lost all train of thought and never asked questions I had prepared , I never asked him when I could start driving again , when my return to work date was , what pains might I feel are acceptable when I do start to put weight on it in 2 weeks . How do I balance the other leg out when I do start walking on it .Never asked how much PT should I do for the 4 weeks before I see him next .
I even forgot to make the appointment for my next visit in 6 weeks .
I asked him could I even start to put weight on it after 11 days as myself and the family where going away for a few days and he said basically its at your own risk , I don’t want you to have to start again.
Basically down to my own lack of composure during the appointment , added to the fact he was so adamant in his refusal to budge on the time scale and despite the fact I now have NO cast on ,
I left the hospital feeling empty !!!!
Not sure how I feel now , as is too early in the morning .
October 16th, 2010 at 9:59 am
Phil, I wish I could tell you that your frustrating “empty” feeling after a visit to the Doc was unusual, or the result of your “blowing” the visit. . . but it’s pretty common, and seems to come with the system. Sadly, a meeting of a patient and a surgeon is hardly ever a meeting between two grown-ups who treat each other like equals. Even if you’re more educated than 90-99% of surgical patients, too! I was lucky enough to have two surgeons who at least LOOKED at (and palpated) my leg each time, but after the op for my first ATR (late 2001) I still always felt like a kid taking too much of my OS’s valuable time! (And you know how pushy I am!
)
There are some tricks that help — like making a list of questions and keeping it in your fist during the visit! (And you could add “Do you mind examining my leg?” to your list!
)
I’m not sure if anybody here knows whether your unusual protocol is perfect for your leg’s particular situation, or just a quirky PITA, or somewhere in-between. (If your operation trimmed the already-partly-healed tips of your torn AT before stitching them together, I’d expect the healing process to be similar to everybody else’s — but that’s just a guess based on a hunch, and from a fellow patient!)
If you’re in a life situation where you can stay out of scary places — NO crowded subway stations or airports!! — and you Watch Your Step, then you’ll probably be fine in shoes now, though your sequence — getting into a shoe while still NWB — is certainly unusual. There’s no benefit to panicking, but LOTS of benefit from being super-cautious to avoid “faux pas”.
If it’s easy and affordable enough for you to get a boot, I think I would. And I’d even make it a HINGE-able boot, like the highly recommended Vaco that’s advertising on this site. You’d start out with the boot “fixed”, e.g. at the same angle as your current 2cm of combined heel lift. But as you transition toward FWB walking and the stage where most of us get into shoes, you can adjust the boot so it “flaps” foot-down (but not foot-up dorsi), as a safe transition back to normal walking.
Building up your other shoe and foot becomes important as you transition away from NWB. Makes no diff while your healing foot is up in the air, so you have some time to think about it.
Hang in, stay sane and positive, good luck, and good healing!
October 16th, 2010 at 12:39 pm
Hey Phil,
In your last cast what position was your foot in? Neutral? Partial angle? DO be VERY careful. I don’t need to say it, but will anyways. Mis-step will have you start from the beginning. I’d send you my boot if I had to, but mine’s only a neutral position boot.
October 16th, 2010 at 5:40 pm
Hey, I’m sorry the visit to the doc didn’t go as planned. You seem to have come away with more questions than answers and he doesn’t seem to have been very supportive. Telling you that putting weight on it was at your own risk wasn’t exactly helpful, he should have been clearer in explaining what it was safe for you to do. Don’t leave it until your next appointment, ring his secretary and explain that you left your last appointment with important questions unanswered I.e. Driving and returning to work and that you’re not sure how to look after your ankle in the next 6 weeks. If an earlier appointment is not forthcoming , ask to schedule a phone call to discuss your concerns.
On a positive note, physios are often much more informative on rehab protocols and you are probably more likely to get sensible answers, especially regarding ADLs (activities of daily living) so it might be worth discussing with them when you call to make an appointment .
Don’t take no for an answer and don’t be afraid to make a nuisance of yourself. Doctors are often unaware of their lack of communication skills, and are often under the impression that they have explained everything clearly when they have done nothing of the sort!
October 16th, 2010 at 11:54 pm
Phil, I left a post above that only I can see, because it’s “awaiting moderation”. I have no idea — maybe ONE smiley is all we’re allowed, or I put in too many quotation marks??
Anyhoo, please approve it when you log in.
October 16th, 2010 at 11:57 pm
If you folks (Elsurfer & Phil) wanted to do the boot handover thing, a neutral boot with 2cm of heel wedges should give Phil the same ankle angle as his shoe with 1cm inside and 1cm outside. (And a heck of a lot more support and immobilization, of course!)
October 17th, 2010 at 3:15 pm
Hi ,
thanks as always for the replys.
elsurfer thank you for the offer but after I posted on saturday , i rang a physio and explained to her the suitation and she said she had an Aircast boot and wedges to make up the 2cm. So as I was afraid of leaving my leg “loose ” I went and bought it from her and have it on as I type.
Again thank you for the kind offer .
Originally my foot was pointing down at an angle , and on friday the doctor said he wouldn’t normally do that but as it was a month between suffering the ATR and getting the op , he had to do it and this is why i had to wait another 2 weeks to bear weight .
“Mis-step will have you start from the beginning”
I keep thinking this , as I said when the cast is on I hated it but really felt vunerable when it was removed .
norm , your right too when you said ,
“And a heck of a lot more support and immobilization, of course!)”
Im wearing it though the day and in bed (the wife is delighted with that :>) ) and when im sitting down i take it off and am moving and twisting my ankle a bit (not much).
This boot has my foot in the “normal” position when i wear it so this has to be a good thing , right ?
teresa , your right , i have palnned to ring his office tomorrow with my questions and get some answers . Basic question I got “stage fright” and forgot to ask on friday ….
I presume as you say the physio will be more helpfull , that my doctor is going to put the rehab totally in their hands . I intend to ring one tomorrow and book an appointment for 2weeks and ask them advice on what to do in the meantime.
Are there any blogs here that I should look at regarding poeple going a step too early ?
October 17th, 2010 at 5:21 pm
Phil, if you search the site for (say) “rerupture”, you’ll find many of the people who took it too fast (or got unlucky).
You say the boot has your foot in the “normal” position when you wear it, but you also said you got it with 2cm of heel wedges. Are you using the heel wedges? If so, then your foot is plantarflexed by that much (maybe 10-ish degrees, though applying the trig isn’t trivial), not neutral.
Whether your ankle agle (neutral or 2cm) is a Good Thing or not depends! Your Doc seems to want you with a 2cm of heel lift (in your shoes), and presumably expected you to take them off for sleeping. If walking in the boot, FWB, without the wedges, seems comfortable, I’d take that as a sign that you’re ready for it. (Many folks here felt discomfort or pain when being adjusted toward neutral by their Docs — NONE of whom changed their minds about it!) No MD after my name, as you know. . .
When I was around 5 or 6 weeks post-non-op, my PT said it was time to sleep boot-less, and I did, and it seemed fine. The risk of having your wife kick you so hard you hurt your AT, or getting tangled in the sheet so badly you hurt your AT, should be fairly remote — especially if your Doc thought you could already walk in shoes!
The main complication reported here, from sleeping bootless too soon, is discomfort in the morning, from resuming the boot’s ankle angle instead of the more extreme PF angle that’s often naturally assumed during sleep (”gravity equinus”). If you don’t have that, I’d keep sleeping bootless — just my $0.02.
If you can install the ATR Timeline widget (instructions linked from the Main Page, a few paragraphs down), it would be helpful to your “followers”!
October 18th, 2010 at 4:21 am
Hi norm,
only read your original post AFTER i wrote mine yesterday.
Your right he looked at my leg for a couple of seconds and said that looks good .
Dont know if he meant his handy work or my leg !!!
“your unusual protocol”
so mine isn’t normal?
“Are you using the heel wedges?”
yes I have the wedges in the boot, Obviously my foot was at more of an angle while in the cast , so i thought over the next 2 weeks this would help prepair me to bear weigth by allowing my foot/ankle to gradually readjust the angle !?!?!?
As for sleeping he gave me half the cast and told me to put my leg back into it in bed and just wrap a bandage aroung it to keep it secure !!
I tried this and found it really hard to squeeze my ankle area back into it .
Plus as the cast has the foot pointing down I thought that going BACK to that position for 8hours a day while sleeping would NOT be a good idea.
Dont know if anybody else was told to do this either ?
Thanks again.
phil