3 weeks Post Op & a long journey ahead!

Hello fellow ATR’s,

I’m also a recent addition to this infamous club.  I’m very happy I found this site as I was sent home a couple hours after surgery with no instruction on how to take care of this injury.  This site has been so helpful in letting me know about everything ATR related!

Well, my story is similar to a lot of people here it seems.  I’m an active 29 year old male & was physically in the best shape I’d been in for a long time. I filled in for a mate’s indoor football team on 13th May, pushed off my left foot to accelerate for the ball & then felt the dreaded “snap” & down I went.  For a split second I thought my heel went through some crack in the floor, but I quickly came to the sorry realisation of what I’d done.  I did feel that both of my Achilles were pretty tight during the game (but in particular the left one).  I tried stretching them & the calf out during the game, but obviously this was not enough.  I tried to cling onto the hope that it was not my Achilles or a just slight tear, but the next day I visited a sports doctor who delivered the news I feared….complete ATR….gutted.

I went in for surgery on 24th May morning @ about 8am & was back home at about midday.  Before finding this site (which I did at about 3 days post op), I really didn’t have a clue about how to take care of this injury. I went through the public system, so was in & out before I knew it, with no instruction whatsoever!

I pretty much spent the first 2 weeks post op on the couch 24/7. My first post op meetng was at about 10 days, upon which my surgeon initially informed me he wanted me in a cast for 8 weeks!  My surgeon was quite old & appeared set it his ways. However, I eventually convinced him to get me out of the cast & into a boot at the next post op visit, 2 weeks later (next Monday). I’m trying to follow a more progressive rehab protocol as a few people here seem to highly recommend. I wish I could progress onto PWB sooner, but given my surgeon is quite conservative I can only try!

What’s inconvenient is that I actually live & work in London.  I was back in Australia for my best friend’s wedding. But with hindsight, I’m actually thankful for the fact I did this over here in Australia (if it was due to snap anyway!) where I have family & friends to take care of me in this initial period!  You really do realise how fantastic & loving your close ones are in a period like this!

My work in London has also been great & has allowed me to work off my laptop.  But I do need to get back to London & I’m hoping to go back at about 4-5 weeks post op. I work as an accountant, so will be working at a desk which should hopefully make things a bit easier.

I’ve read through many posts on this site but just have a few queries that would be great to gain an opinion on:

  1. Elevation - I’ve read that you’re meant to keep your leg elevated, but for exactly how long?  For example, at about 15-16 days post op I decided to go to the gym to do some upper-body work.  I’m a bit of a gym junkie so the lack of gym was having a negative impact on both my physical & mental state.  As such, I spent around 2 hours there (including the travel to & fro) with my leg not elevated.  I did feel some throbbing, but it was nothing I couldn’t handle.  Do you think this is OK?  I’ve also visited friends for dinner (having to keep my leg down).  I’m hoping this won’t have a detrimental effect given it’s over 2 weeks post op?
  2. Stairs – one of my big concerns with going back to London is the stairs! My London apartment has 3 flights of stairs and also taking public transport tends to involve climbing stairs (e.g. tube stations). How long before you think you can talk up stairs fairly ably independently?  I’m thinking I should probably take a taxi for a while!
  3. Flight – Has anyone ever taken such a long haul flight about a month after surgery.  I’ll be out of the cast & into the Vacoped boot by then & have also been advised to take a blood thinning injection.  I hope this will suffice, but is still a bit of a concern given such a long flight (about 24 hours).

Many thanks & happy healing!

27 Responses to “3 weeks Post Op & a long journey ahead!”

  1. Hi, this is a comment.
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  2. Once you’re FWB in a boot, stairs are OK. On crutches, they can be done OK by some of us, better by others, and not at all by some. See RyanB’s video for a look at “better”. There’s one fancy ($$$) crutch substitute - the iWalk?) that let’s some users walk stairs OK with the weight on your knee. But real crutches are best for PWB, the transition to FWB.
    Elevation is a Good Thing for controlling swelling. It can be done in friends’ dining rooms and all kinds of restaurants! Swelling isn’t good and should be controlled, but it isn’t clear that a few hours of it does lasting harm. It’s even conceivable that short-term swelling HELPS by improving circulation, like filling and emptying a bucket. (100% unproven hypothesis.)
    Airports will usually provide wheelchairs or rides on carts. How hard to fight DVT/PE clotting - with and w/o either long flights OR an ATR! - is an interesting judgment call, with hugely varying judgments from experts and patients and passengers. Always good to get up and stretch midflight, stay hidrated, maybe take ASA (81g?), maybe even more like Heparin.
    Good fast modern rehabs (like the 3 Cecilia summarizes) rock, but post-op (UNlike non-op), the main issue is nuisance rather than bad outcomes. But spending extra weeks crutch-walking 3 flights of stairs might be more than a simple nuisance…

  3. I’ll attest to stairs in the boot. No problem in the boot even without crutches when FWB. I started doing stairs without the crutches in the boot around week 8 and wouldn’t be surprised if you could do it earlier.

    I have the same hypothesis about swelling at that stage. I don’t want to use ice to reduce swelling anymore because that also reduces circulation. It helps to flex my gastroc while sitting around in the boot, and elevation for a little bit makes the swelling go away completely.

  4. Thanks for the tips normofthenorth & Roark! I think I’ll move in with some friends who don’t have stairs when I initially get back to London and move to my apartment when I reach FWB stage. Last thing I want to do is do some damage while trying to negotiate the stairs on crutches on my own!

    And yep, I’m deciding to keep on going to the gym & keep my upper body in decent shape. Can’t stay elevated 24/7 after 2 weeks or I’ll go mad! I’ve been a couple times now & usually my leg appears fine once I get it elevated straight afterwards!

    One final question I did have is how long does it generally take after you reach FWB to walk decent distances (say 30 minutes non-stop)? Is it still a case of walking a few metres then having to rest the leg for a while once FWB?

    Thanks again for the advice, looking forward to my 2nd post op in a couple days & getting onto the boot!

  5. We’re all pretty different, Raj, but by a couple of days after I started FWB (a couple of days after 4 weeks, for my second, non-op, ATR) I was walking comfortably for good distances. I think standing is often worse than walking, because a lot of the discomfort is from fluid pressure, and the leg muscles control it during walking. Even sitting without elevating got uncomfortable pretty soon for weeks and weeks — see my blog page “This swelling and elevation is getting OLD!” — but walking wasn’t too bad, almost from the start.
    At 7 weeks post-non-op, I put myself into an old hinged (”ROM”) boot that I had left over from ATR #1 (surgical and super-slow), and that speeded up my walking even more — to the point where I was actually walking than a good-sized bunch of my younger uninjured friends! Of course, after that, going to 2 shoes is a major setback, but it’s got to be done. . .

  6. About stairs: For most of us, going downstairs on crutches was hairier than walking up (needing “commitment”, like skiing a steep run!), EXCEPT if you have a strong banister on the same side as your injury. Then you can put both crutches in the other hand, and walk down the stairs pretty quickly and securely, leaning hard on that banister. Unfortunately, I don’t think any version of that works on the way up.
    The other good trick is to use a fast rehab protocol — like bit.ly/UWOProtocol or one of the other 2 listed at …/Cecilia/Protocols — that will get you to FWB by about 4 weeks post-whatever. That way, you don’t have to spend much time on crutches, doing tricky things on the stairs.

  7. @raj - I started walking long distances fwb in my boot fairly quickly. By week 6-7 I could do 20-30 minutes of walking no problem at a decent pace and even did 2 mile walks by week 8. Just listen to your ankle and don’t push it.

    Where I ran into trouble was at two shoes, where you slow down significantly compared to fwb in boot. I thought I could still take 2 mile walks, just slower, and wound up really making my tendon get sore and inflamed until I backed off and started to strengthen it slowly up again. Now at around 12 weeks I probably am comparable in two shoes to where I was at 8 weeks fwb in a boot.

  8. Thanks for the advice regarding walking, great to hear that I should be able to walk some decent distances shortly after getting onto FWB! Must be quite frustrating to slow down after getting onto 2 shoes, but part of the recovery process I guess.

    I just had my second post op today, 3.5 weeks after surgery. So glad to finally get the cast off as I was concerned the surgeon would ask me to stay in the cast for a while longer. However, I got the orthopaedic registrar instead of the surgeon and she allowed me to take the cast off. As much as I tried to prepare myself beforehand, I was still taken aback by the sight/size of the wound/stitches. The level of muscle atrophy on my calf was also quite high, but I was more prepared for this that the sight of the wound. Happy to see the stitches comes off, but regretted not asking for an x-ray as would like to of confirmed the tendon was right & in tact.

    Got the all clear to fly to London in a week which was great. The orthopaedic registrar told me not to have the injection, rather to take 150mg of aspirin daily from now until 1 week post flight.

    I was fitted into my Vacoped boot in the 30 degrees equine position. The nurse & the registrar had never seen the Vacoped before so they were quite impressed with it :) The registrar said I could start bearing weight immediately, as much as I could handle (so no specific weight bearing protocol). However, she wanted me to remain in the 30 degree equine position for another 3 weeks (i.e. 6 weeks total post op). Then at 6 weeks, I’m then to assess the wound & then to start reducing the angle 10 degrees every 2 weeks, being in the boot for 8 weeks.

    I feel quite awkward when I try to bear weight on the Vacoped. Due to the angle of the boot, I can only really put weight towards my toes rather than through the sole. This is the case even with the wedged sole. Seems like I’ll only be able to get rid of the crutches once I reduce the angle of the boot. Did anyone else have this feeling? Just feel that I may not be putting the boot on correctly.

  9. The boot has to be snug enough to transfer your weight from your toes to your shin. On crutches, you should be able to roll your boot from heel to toe and gradually load it up until you don’t need the crutches in a couple of weeks. WBAT = WB As Tolerated. Bit.ly/UWOProtocol started it at 4 weeks post-op or non-op.
    But if you don’t build up your other foot to match - e.g. with Vaco’s EvenUp - you’ll be seriously lopsided, which is a Bad Thing!

  10. Thanks for the tip Norm. Never even knew about the Vacoped Even-up device, so will look into getting that.

    I just tried crutching as you suggest, by rolling my boot from heel to toe. However, it feels like that in order to do this I have to extend my injured foot further forward than normal in the stride to ensure my heel touches first?

  11. Actually just got told from the Vacoped people that I should only start to bear weight & use the wedged sole once I move down to 15 degrees! Was wondering why it felt so strange to try & weight bear at 30 degrees!

    Bit weird as my surgeon still wants me to keep my foot at 30 degrees for 3 more weeks, but they also said WBAT…this whole thing is so confusing at times!

  12. yeah, you can weight bear as tolerated using the crutches at 30 degrees. You can start weaning off the crutches when you get down to 15-20 degrees so maybe that’s what they meant. Imagine you’re walking in high heels. Yes you do have to extend your boot a little bit further in front of you to plant your heel first and rock forward. Just use the crutches to support whatever weight you need to support.

  13. Raj

    The wedged sole is the big, thick one - not the flatter sole. You seem to be saying that the wedged sole is the one that you move to. I’m assuming that you have started with the thick (wedge) sole and not the flatter one - which would be very uncomfortable. My rehab schedule recommended beginning weight bearing while still wearing the wedge - that is, from after week 2. It does feel odd and it is so much more comfy when you get the flatter sole 2 weeks later.

    Do you also know about setting a range of movement (ROM) after about week 4? Having an increasing ROM will help to reduce ankle stiffness, compared to having the boot constantly fixed at one angle. Instructions are in the little handbook provided with the boot.

  14. Thanks Roark, yep will try to do the ‘high heel’ approach. Seems the best method to do whilst on 30 degrees and wedged sole in the Vacoped.

    And yes Hillie, I am using the wedged thicker sole initially (as I thought this was the one you’re meant to use initially at the higher angle?). It just feels quite weird to walk on crutches with the 30 degree angle & the wedged sole. I find it quite weird to get the heel down first due to the size & angle of the boot, but will endeavour to do so.

    Thanks for the tip regarding the ROM. However, the orthopaedic registrar told me to keep my foot locked in at 30 degrees for another 3 weeks (i.e. total 6 weeks @ 30 degrees post op). I’m going to try & keep it locked in 30 degrees until I see a physio in London next week (which should be about @ the 4.5 week post op mark), & hopefully can start to engage in more ROM & a more aggressive approach.

  15. Also is it normal to have pain on the instep of the foot with the vacoped after a while? I couldn’t sleep last night because of it, so loosened the bottom strap which alleviated the pressure & the pain.

    I’m just concerned that by not having the bottom strap as tight is allowing my leg to creep above to not be at the required 30 degrees? Not sure if anyone else has had an issue with this?

  16. Raj

    Maybe I misunderstood your post where you said: “use the wedged sole once I move down to 15 degrees”. Made me believe that you were not using it yet whereas it is for using early on as you say.

    True that some doctors are much more conservative than others. Current thinking (and the experience of many here) seem to indicate that a fixed 30º up to 6 weeks is not best for a sustainable recovery and increasing movement.

    Whatever, by 10-12 weeks most here seem to be at about the same stage, well out of the boot, driving, and increasing their walking distances.

  17. That pain is pretty normal, I got all sorts of different hotspots in the boot at night. I also loosened it a bit so don’t worry about it too much.

  18. Raj

    Concerning your pain issue - the vaco boot has a bead filled liner which is stiffened up by withdrawing air from it. Have you tried to move the beads around a little? They can accumulate in the wrong places sometimes.


  19. Thanks both. Will try move the beads around a bit more & see how that goes.

    I believe the pain was more to do with the front shell placing pressure on the front instep of the foot. As such, I ended up removing the front shell & having just the bottom shell strapped around the liner (which seemed to do trick). Not sure if this is the best thing for safety, but my leg appeared to be fairly secure in the equine position & wasn’t as painful.

  20. Sorry, final tedious question. There’s no major issue with putting my pants inside the vacuum liner of the Vacoped is there? Just a bit easier than trying to find pants big enough to fit around the outside…

  21. raj29, I have an AirCast, not a Vacoped, but I occasionally have worn “regular” pants and fit them inside my boot without any problems. I just was careful to keep the pants smooth on the back of my leg (over the Achilles) and fold them over in the front. You don’t want any wrinkles adding undue and unwanted pressure on your Achilles. But, for the most part, I’ve been wearing Nike black athletic pants (with the side zipper at the hem) for the past many weeks–they’re comfortable and they stretch around the outside of the boot. -David

  22. I think the Vacocast is too snug to try to wear pants inside the liner. I tried, and it just did not work . I gave up, and just decided to wear shorts until I am out of the boot. To be honest, wearing shorts to work has been one of the “silver linings” of hhis injury!

  23. I also wore jeans inside my vacocast. Smooth in the back and folded over in the front. No problems.

  24. Thanks again, the front pant fold technique does the job nicely. Being of Sri Lankan origin, my calves were skinny enough before the rupture, so with the added muscle atrophy I can easily fit my pants inside the Vacocast!

    Ended up seeing a physio mate of mine today to just get a b

  25. Thanks again, the front pant fold technique does the job nicely. Being of Sri Lankan origin, my calves were skinny enough before the rupture, so with the added muscle atrophy I can easily fit my pants inside the Vacocast!

    I actually ended up seeing a physio mate of mine today just to get some further advice before flying out (now 4 weeks post op & 3 days since I got off the cast & into the Vacocast). I removed the Vacocast off & he asked me to try to move my foot upwards towards dorsiflexion. I tried but I could barely move my foot up which was a bit disheartening. I didn’t quite expect the mental trepidation I had to even try this! Just reminded me the long road I have ahead! But gotta keep plugging away!

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