ATR in the UK - Living with an Aircast boot

Hi - this is my first real blog post, though I have posted one or two comments on the site before.  If you haven’t see those, as a bit of background, I’m 52 and live near Southampton in the UK.  I’m pretty active, playing badminton weekly, doing martial arts twice a week & cycling 30 miles every couple of weeks, but on 30th January I suffered a complete ATR while playing badminton.  I guessed what had happened immediately as one of the guys I play with also had ATR about 20 years ago, though as I could still move my foot a little I thought it might just be a partial tear. I went to A&E (ER) that evening & got a half leg cast with my foot at about 30 degrees, an appointment with a consultant 8 days later, and advice to hang the leg up & behind when using the crutches. I’m not good at sitting doing nothing so after the first 24 hours I was up & doing what I could around the house on 2 crutches or 1 crutch & a stick, & managed to do a 400 yard circuit to the shops once, though found it pretty tiring. All Non Weight Bearing other than the very slightest sometimes needed to maintain balance e.g. taking a leak!

I saw the consultant on R+8, and an ultrasound showed it to be a complete tear in the musculotendinal area with a 3cm gap.  The consultant said this wasn’t appropriate for surgery, so the non-surgical path was agreed and I was prescribed an Aircast boot with 3 wedges giving about 20 degrees of flexion, which I was fitted with the day after.  I was referred to physiotherapy, who the consultant said would remove a wedge every 2 weeks, which I assumed would start 2 weeks after I saw him, i.e. R+22.

I was fitted with the boot the day after (R+9) & didn’t get much advice on using it with crutches, but found it was a lot easier to get around in than the cast was. As a result I stopped just hanging my leg when using the crutches, instead putting my injured foot forward with the crutches and putting a very light load on it so creating a partial walking motion, and with a bit more load on the injured leg around the house using 1 crutch on the injured side only.  It’s also a lot easier to stand without crutches (taking a leak, making breakfast) though almost all of the weight is on my good leg.

Perhaps as a result of being more active I seemed to get more swelling in my calf and ankle in the first couple of days with the boot than when I was in the cast, especially late afternoon and evening, to the extent that it became uncomfortable and there was a bulge above the top of the boot and either side of the elastic of my sock when I took the boot off.  I started taking it a bit easier & elevated my leg more for a while, but it didn’t last because as I said I’m not good at sitting around.  Also my wife’s having to do a lot of stuff I’d normally do, particularly running the kids to clubs etc, so I’m trying to do what I can around the house - sweeping and using the vacuum are both perfectly feasible, and I’ve been able to do a bit of light gardening as well.  The swelling did decline after a couple of days, but the lower calf, ankle and instep are all still a bit swollen; keeping the boot fairly tight when I’m up and around seems to help.  I’m keeping it on at night because I’m worried that it would be very easy to change position in the night and do myself some damage, but I do slacken off the Velcro straps and the fleece liner a bit.  Something I didn’t enjoy was when getting up in the  morning there was an uncomfortable feeling of swelling in my calf & foot, as if blood or other fluid was gradually flowing down as my leg became vertical; again tightening up the boot before getting up seems to help with this, but it still happens a bit.

This is where my learning curve about NHS services began.  By last Thursday (R+17) I hadn’t heard about the physio, so called them instead, to find that it had taken a week for the referral from the consultant to reach them, nothing had been scheduled, and the earliest they could see me at the hospital was 14th March (R+43).  As there is another physio unit much closer to where I live, I asked if they could give me an appointment there, but that one is run by a different NHS Trust, and to get a referral there I’d have to speak to my GP.  I called the local unit to check that was correct; it was & at that time they were booking for March 6th (R+35).  I then called my surgery, but had missed my doc that day, and he was off the next day, but they said to phone the following Monday (R+21)  for a telephone consultation.  This I did, only to be told that they hadn’t received a letter from the consultant about my diagnosis & treatment (even though I’d received it the week before) and without it the doc couldn’t talk to me.  So, I took a copy of the letter in to the surgery & the doc called me later that day to confirm that yes he would refer me to the local unit.  I only go into this level of detail to illustrate what I’ve learnt about treatment on the NHS:

1) It’s brilliant at critical care, but once you’re beyond that point things grind rather slowly.   2) Communication is really slow & a bit unreliable (do they really have to use letters, isn’t there an intranet?)  3) The structure means that it’s not as joined up as you might think.  If you’ve had non-critical treatment with the NHS you’ll know all this, but I’m fortunate to have been pretty healthy so if like me you lack the experience, my advice is: a) Don’t wait for things to happen, chase them up but be nice, they’re very busy),  b) If you have private health insurance then use it, you’ll probably get earlier treatment, and   c) Use the info on AchillesBlog to find out what your options are so you can have informed discussions with the staff.  It’s been 4 days since I spoke to my doc and I’ve heard nothing, so I’ll be speaking to the local physio unit on Monday.

Back to the Aircast boot & some random practicalities.

  • I cut the elastic tops off the socks I’m wearing, which has made them easier to put on and may have helped to reduce the swelling in my calf.  I can take a bath with the boot on, resting my leg on the side, and give my foot a sponge bath every day.
  • If I’m honest the fleece inner of the boot is becoming a bit whiffy even though I’m sprinkling it with talcum powder every day, so it’s going to have to go in the wash on a day when I can put my foot up for a couple of hours while it dries.
  • The Velcro on the straps is the noisiest I’ve ever come across, so if your partner’s gone to sleep before you go to bed, slacken them off in another room first!
  • It is possible to carry a hot drink in your free hand while using one crutch if you cover it with cling film, but take it off asap before it welds itself to the cup!
  • The air bags in the boot seem to lose pressure even if you close the valve; check them every coupled of hours.

In the last couple of days I’ve started to feel the need to stretch my injured leg when I wake up, which I’m resisting, but I hope is a sign that there is now some sort of connection between the muscle and the tendon again.  There’s also a slight pull when I - very carefully - raise my foot beyond the angle it’s got used to in the boot, which maybe confirms this.  I’ve read on here that if the tendon heals too long it’ll be less strong, so hopefully if the delay in getting physio means that it heals a little short due to being longer in its current position before the first wedge comes out than that’ll be a good thing, even if I have to work harder at the physio to stretch it.  I’ll post again once I hear about the physio appointment.  Cheers for now,  Richard.

7 Responses to “ATR in the UK - Living with an Aircast boot”

  1. Hello Richard. Like you I am UK based, and am also going through the non-op recovery route with the NHS. And also like you I ruptured my achilles playing badminton! I am now at R+13.5 weeks. My recovery timeline has been similar (perhaps a wee bit slower) than the modern non-op protocols on this site. I was in a plastercast and NWB for 4.5 weeks; then into an aircast boot, 2×1cm heel wedges FWB; removed first heel wedge at 6.5 weeks; removed second heel wedge and into neutral in the boot at 7.5 weeks; started barefoot walking (well, shuffling) in the house and stopped sleeping in the boot at 8.5 weeks; out of boot and into shoes at 10.5 weeks. After 3 weeks in shoes I can now walk at a normal pace, for a couple of miles at a time, and have started cycling at the gym. I generally tried to follow a protocol like the ones listed on here (in Cecilia’s blog) and would recommend doing that; particularly early weight bearing. I also wouldn’t be too worried about not getting physio until R+35 - I didn’t have my first physio until R+37 and I don’t think that it has really held me back.

  2. Hello Don. Thanks for the info; if I can walk a couple of miles at a steady pace by the end of April my wife will be very happy as I can take back the school run after Easter and she’ll be able to start working normal hours again! I’ll check out Cecilia’s blog for those protocols as well. Cheers.

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  3. Hi Richard,

    I posted this on Evan’s blog but it hit moderation and I’m not sure if he’s around to moderate it!

    You describe pretty much exactly how I felt at your stage but what I learned was - don’t stretch it. You don’t need to stretch to align the collagen fibres, but you should try and weight-bear in the boot “as tolerated”, working towards full weight bearing. This will help with blood flow and swelling as well. Where are you in the UK? I bought an “evenup” shoe leveller thing but never ended up using it, I figured I could donate it to someone in need :) Personally I found I could just walk with the “bad” knee bent instead, ended up quite comfortable.

    I had one physio session before I got out of the boot, there’s not much you can do really until you’re out of the boot so don’t worry too much about that. I outlined the exercises and more about stretching the tendon in this post:

    I’m NHS/non-op coming up to 10 weeks, excited to reach Don’s stage of walking!

  4. Hi Morcs. That blog post was really useful thanks; so no stretching for me until told to by the physio. I got the letter confirming my referral today and will phone to book 1st appointment on Monday, but it’ll probably be mid-March before it happens, in which case it’ll be at around the same stage as your 1st one was; it’ll be interesting to compare the treatment & advice I get with yours. I find it’s a lot easier getting around in a running shoe than in slippers because of the lift it gives my other leg; I looked at the Evenup shoe leveller, but couldn’t believe the price - I won’t be laying out £60 for one any time soon. Think I’ll wait until the 1st wedge comes out then add a gel lift to my running shoe which should bring the effective length of my legs quite close together & make PWB a lot easier without a crutch for balance. I’ll keep an eye on your blog to see how you’re getting on, cheers for now!

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  5. Hi everyone. I was very happy to stumble onto this site. My surgery is in two days and it has been so informative to read everyone’s experiences. Looking forward to having my blog site posted so I can write everything out. Technically I should be NWB and have the wedge boot, but I’m trying to get things done before Tuesday. It’s just my daughter and I….she is 18 and these are the two weeks before musical so she is so busy.

    What is your best advice for the day of surgery?

    Thanks everyone!

  6. Hello Jennifer. I can’t offer any advice on preparing for surgery or the day itself as I’m on the non-surgical treatment path. However I’m sure others who have been down the surgical route will chip in, and there’s also some good information on the main site: on the home page if you look at the list of pages down the left hand side there are what look like useful entries under Rupture to Recovery > Preparing for Surgery and Surgery day. I hope they’re helpful. Best wishes for the op and for the start of your recovery. Richard.

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  7. Hi Richard, I don’t mind passing on my Evenup - it’s (hopefully) no use to me now! All I’d ask is you do the same for someone else here when you’re done with it and we get a chain going :) It’s a “Large” (I’m size 10 but I guess it would be the right size for most adult males).

    Let me know and I’ll try and work out a way of getting you my e-mail address without posting it on the public blog!

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