Remedial Case?
As I read posts many of you speak of exercising and PT and even swimming in as few as four weeks after surgery. For me, surgery was six weeks ago and I am in a hard cast and foot pointed down. After seven weeks I get another cast with foot placed in neutral position for three more weeks. Then I finally get a removable walking boot.
Am I a remedial case or have others been on the same program?
July 22nd, 2012 at 5:22 am
For me, I was in a cast for 5wks and 2days and then got given a hinged boot which was adjusted to give my foot movement in on direction and stop me form moving my foot toward my knee and over stressing the tendon as the healing continues.
The plan was to adjust the boot over the next 6 weeks to allow me to bring my foot to that neutral position… I am working ahead of that right now
What you get by going from cast to boot is the opportunity to engage in moving the ankle and waking up/working those muscles that you need for walking again…
For quality of life - it also allows some weight bearing and the chance to loose the crutches around the house (and more as the weeks go by).
Eventually we all end up at the same place at around 12 weeks, but there’s a medical study (http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/) that provides stronge evidence that early mobilisation into a boot prevents re-ruptures.
It’s worth asking your doctor about the protocol you are on right now and understand why you are not being mobilised earlier and take it from there I guess.
July 22nd, 2012 at 6:13 am
So, it will be 10 weeks in a cast. As most, but certainly not all of us here finish with our boots by around then, I was wondering if there are complications in your case, especially as at 6 weeks a neutral position for the foot would be hoped for, with a range of movement from neutral down to about 30º (with a hinged boot that is).
A face to face with your doctor looks called for unless there are issues with the injury that you haven’t mentioned.
July 22nd, 2012 at 8:49 am
10 weeks! Wow - I went to the boot at 2 weeks and shoes at 8 weeks. Everyone’s different and I don’t know how bad your injury was or if they’re any other factors that might affect your healing but 10 weeks seems like a long time to be in a cast. You need to ask your doctor why he (or she) thinks this is necessary. I’m already a little nuts but I would have been absolutely insane after 10 weeks in a cast.
July 22nd, 2012 at 8:57 am
Hi Riptorn, I was 9 weeks in a cast, 3 weeks equinus, 3 weeks mid way and 3 weeks neutral. After that, my doctor suggested a boot but I said I wanted to drive so he offered 2 shoes with wedges. I am now 12 days in shoes and feeling good, still walking with a limp but improving flexibility every day, and able to walk a bit barefoot. I haven’t felt too vulnerable going straight to shoes from cast, and seem to have made comparable progress with those who have been in a boot. So far, I ‘m not sure the cast has been such a problem!
July 22nd, 2012 at 12:09 pm
Hi there,
I think your case does sound very conservative. Have you looked at the UWO protocol on Normofthenorth’s blog. Maybe take that along to your doctor but as Hillie says are there any issues with your injury?
July 22nd, 2012 at 1:08 pm
The only issue the doc talked about was that he said the tendon looked like shredded chicken. So maybe I tore it up a bit more than the typical case. When I tore it I felt three separate and distinct pulls. I just assumed it was typical. Maybe not. I’ll talk to the doc and get the details.
Thanks for all the input!
Good Healing To All.
Rip
July 22nd, 2012 at 1:15 pm
Hala
Great to hear that you’ve good progress in spite of the limitations of a cast. I was glad of my boot after week 2 as it gave me mobility and stability that a cast couldn’t, lose the crutches, and the opportunity of light exercising to reduce atrophy in the calf muscles.
No getting away from the fact that Riptorn’s progress is unusually (?) conservative for some reason. Ironically I have just looked at the title of my printed protocol and been reminded that it is for ‘Complete AT rehab - conservative or surgical management’ - yet it is into boot at week beginning week 3, out of boot end week 8. Practitioners at my clinic actually have called it an accelerated or aggressive protocol. Still, what’s in a name?
UWO+…
July 22nd, 2012 at 1:20 pm
Riptorn
Our responses crossed over!
‘Shredded chicken’ sounds like quite a big deal. Still, long cast periods though.
Happy healing.
H
July 23rd, 2012 at 1:31 am
I’ve never seen any evidence that going slower than bit.ly/UWOProtocol has any benefit. Good news is that extra-slow protocols don’t SEEM to do much harm post-op — they seem to do more harm post-non-op, the way I read the bulk of the evidence. But they are always a nuisance and don’t seem to do any good, either.
It’s conceivable that you’re being sent on the slow road because your ATR was unusually messy, but again there’s no evidence that messy ruptures respond better to slow rehab. It sort of sounds logical, but most logical propositions in ATR cure get smashed when they’re put to the test of a real study. . .
July 29th, 2012 at 12:58 pm
Today I looked on line and once again see everyone recovering faster than me. It gets a bit frustrating…I know we all occasionally get frustrated and not whining.
I did see a photo with the scaring and stitches. The incision looked about 4 or 5 inches long. Is that the typical length? Mine is a hefty 10 inch cut up the back of the leg. Regardless, I am still in a hard cast in the original forward pointing position. I was suppose to get cast removed on Monday July 30th but doctor had an emergency. Have to wait another week to see doc and get cast removed. It will be seven weeks since surgery and will finally get another cast. Yes, the doc said it looked like shredded chicken when he was surgically repairing tendon. This is going to take forever at this rate. Is anyone else on this “slow boat to China” recovery program?
July 29th, 2012 at 2:20 pm
Hey Riptorn - I blew my AT to pieces, had a lot of “loose ends” cut off, and have a fairly long scar. (not 10″ though) You can check my blog for my timeline - my doc is pretty conservative and I had very limited DF causing some of his reticence to let me out of the boot. I had a boot at one week, PWB- at 4 weeks, FWB at 6-7, and out of boot at 10. I’ve been doing PT since week 4 (stationary bike, etc.) I insisted my doc change my cast from pointed down when I heard that you could heal really short - and then insisted on going to the boot 2 days later. He was pretty accommodating when I told him why. Just email your doc and ask his reasoning.
July 31st, 2012 at 11:23 am
You are not alone! I am also on the “slow boat to China”. I had an initial ATR on 1/2/12 surgery within a week and did the fast rehab. 3 weeks in a cast and on the boot. I reruptured on May 20th. My second surgery scar like yours is at least 10 inches long. I had quite a bit of tendon removed. Currently I am in week 7 of NWB full cast. At 8 1/2 wks the dr has agreed to let me go to the boot although he is still saying NWB in the boot. There are clearly different recovery plans, but having done both I will take slow and steady.
August 1st, 2012 at 11:07 pm
Talked to the cast maker the other day. He gave me a good simple explanation; your not 30 years old (57) and you don’t heal as fast as you once did. The other point was the shredding of the tendon, it was not a simple tear. He told me to leave the cast on until next Monday and see what the doc says. Good enough explanation for me. Some day it will be fine. I am just looking forward to a shower and no bag over the cast. Still feeling fine and very positive.
August 20th, 2012 at 12:47 pm
RT, I did my 2 ATRs at 56 and 64. After #1, I found a 20-year-old undergrad in the Sports-Med clinic who was a few weeks ahead of me, so I kept in touch with her. A month or two later I stopped talking to her, as a favor to her. My recovery was MUCH faster than hers at every step. And stronger and walking straighter, too, and with less pain and discomfort, too. UWO didn’t hold the geezers back, and I’ve never seen any evidence that age matters much for ATR rehab. ~99% of the time when patients assume that their Rehab is super-slow because it’s been personalized for them, they’re wrong, and it’s been personalized for their Doctor, sorry.
August 20th, 2012 at 5:26 pm
Norm,
Thanks for your words on wisdom. After surgery, one week in a splint, five weeks in a cast, four days in a boot with full crutches, day five boot and crutches in the garage for good. Two shoe and walking well, some swelling, jacuzzi in the morning and ice at night. I have my first visit to PT next Monday. Have been working on a normal stride with good leg to stretch Achilles and continually stretching tendon while seated.
Yes the doctor had me on a slower program but I am convinced it helped the tendon heal stronger. All stretching has not caused any concern; just the feeling when using a muscle not often used. I think the doc left me in a cast longer because he knew the boot would not stay on long. Oh well, all is good and every day is better. Again, thanks for your input!
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