First off, I want to thank everyone who has commented on my blog; the information has been very useful. Plus, it’s reassuring to hear from others who are or were in the same boat so to speak.
Tomorrow I will be roughly 4 weeks post op. I see my doctor tomorrow and I hope she moves me to FWB so I can ditch the IWalk. But this evening I had some thoughts/questions about this next stage of my healing process. First, I noticed that my aircast is quiet bulky. How on earth td people walk FWB when one leg is elevated above the other? (even with a shoe on!) Second, will the doctor say FWB all the time or just a few hours a day? Or will I still need my crutches sometimes? Third, tonight I tried putting some wight on my injured leg. About 70% and immediately felt some pain in my ankle and tendon. Is that common at 4 weeks? Maybe I still need to heal.
Tomorrow can’t get here soon enough!
Pain in the bottom of the foot (sole and especially heel) is common and normal, mostly a nuisance. Pains in the ankle and tendon are of (much) more concern, at any time during rehab. Many of us followed bit.ly/UWOProtocol and started PWB (with crutches, booted foot on floor) at 2 weeks in, so “FWB as tolerated” wasn’t a problem at 4 weeks in. (And the newer Exeter protocol gets to PWB and FWB a week or so faster). But — in general and in specific — I’d say “If it hurts, back off.”
And as soon as you do get to FWB, it’s essential that you somehow arrange your other-side shoe so that it’s as high off the floor as your booted foot. Three are a few commercial solutions — including Vaco’s “Even Up” — and a number of kludges (like thick hiking boots with some extra insoles).
Leaving your feet uneven will force your body to compensate in harmful ways. At worst, you could injure other body parts (hips, spine, knees); at best, you will probably develop some strange walking style that will be difficult (and essential) to un-learn later.
I was terrified of re-rupture and did not put any weight on foot outside of boot until 8 weeks. I would be very careful with that.
It was impossible for me to walk in boot with huge wedge without at least one crutch. Once the wedge came out I could manage fine and I did always match shoe on strong leg to height of boot on healing leg.
You will get there. Don’t push too fast on putting weight on healing leg.
For me working out the rest of my body - one legged push ups, weighted sit ups, one legged rowing helped me stay patient with the waiting until 8 weeks to put weight on my healing leg without the boot.
Thanks for the comments.
As far as Exeter protocol. My doc says that the newer studies suggest that early weight bearing is associated with more wound complications. Didn’t ask for the cites, but doc has a good reputation in the local medical community for knowing her stuff. I know the various protocols are all controversial.
Pleased to hear that you have a good doctor. Going fwb at 4 weeks isn’t all that slow and you will be ahead of many. However, you mention studies and Exeter and I would suggest that you read the study that came out 4 years after the Exeter programme commenced. Check out http://achillesblog.com/suddsy/2013/06/24/end-of-wk-2-wow-progress/for just one string of posts, including one of mine:
“Royal Devon & Exeter Hospital (NHS) uses the Vaco boot with an almost identical protocol and its results (2008 - 2012) are evidenced at http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_18/16.abstract
246 patients, over 3+ years, non-op and surgical. Amazing low rates of re-rupture i.e. 3 in total.”
The ortho surgeons are named in the paper and your medic can easily email them to find out more. May be pleasantly surprised. Another well reported study is from UWO as mentioned by Norm above.
For my part I haven’t seen a report citing issues with early weight bearing, and if you are talking only about surgical cases, Exeter’s study period reported 2 complications with wound breakdowns and the rehab protocol was identical for op and non-op.
In the comments to one of my studies pages, RyanB and I discussed a recent study that went crazy fast and got bad results. Op and non-op both had high rerupture rates, non-op worse. So it IS possible to go TOO fast, but it’s very very fast, like immediate FWB.
Sally’s fears are real fears, but the evidence says she’s got it backwards: at common rehab speeds, faster WB means LOWER rerupture risk, not higher. Many MDs have that backwards too, but the evidence is super-clear. UWO & Exeter & Twaddle went the fastest and got the best results with fewest reruptures.
I forget who first said “You are entitled to your own opinion, but not your own facts.” Any OS has the right to prescribe any rehab protocol, and most patients have the right to choose their OS. But some protocols produce superior results and some — still popular with some OSs — produce inferior results. An OS can have brilliant surg technique AND a very high IQ and STILL not have read the ATR evidence. What most of them learned in Med School is now old and dead, proven false.