week 8 - boot off

Posted on January 21st, 2014 by Ross

On my week 6 appointment I got my boot stop reset to 0 degrees (flat-foot) and my fortnight running from week 6 to week 8 was one of small improvements and getting more confident taking my boot off, much to the annoyance of my wife who thought I should be keeping it on as much as possible. I did ask the consultant at week 6 about driving and taking the boot off at night but he said I shouldn’t do either - so I didn’t.

Taking my boot of during this period was like regressing about 3 weeks, i.e. it felt like it did whith my boot on 3 weeks ago.

At the week 8 consultation the consultant removed my boot and poked around. streaching my foot up inline witth the other he seemed very pleased and announced I had the same movement as my good foot. Told me to take it easy not to run for another 4 months an not to do any athletic exercise for 2 months (I didn’t tell him I’m still hoping to ski in 7 weeks time). It was then onto my first Physio Therapy session 2 days later.

After examination my physio again said I had excellent movement and predicts an “excellent outcome” for me which is very encouraging. She did ask about my hobbies sports etc, and on metioning skiing asked if I was planning to ski this season. When I replied that I was hoping to do so in 7 weeks she didn’t react with a complete “don’t be silly” that I thought she might instead just rolled her eyes and said “be careful”.

I’ve now got all my streaches and exercises to do - ordered my “sitfit” balance cusion and am now studiously going through the exercises I can.

It’s odd but I think I can actually tell the difference with just two days of exercising!

Two days down and 47 more untill skiing!

5 Comments »

Four through to Six weeks - Crutchless Now

Posted on January 2nd, 2014 by Ross

I’ve not updated this blog over the Christmas period (partly ’cause I failed to get onto it?) so I have a bit of catch up to go.

Week 4 to week 5

I was at my in-laws over Christmas, turning up able to touch my good foot down, but still needing crutches to get anywhere. During the days over Christmas I was waking up every day feeling like there was less pain and being able to put more and more weight onto my foot.  It was during that time that I realised I was managing with a single crutch and could even manage a few tentative steps without. My improvements continued and by the time I left again (28th December I was walking about without my crutches - 5 weeks after my rupture)

Week 5 to Week 6 

The progress throughout this period seemed slower, not noticing daily improvements until a few nights ago (3oth Dec) when I realised that i was managing to swing my good leg through past my bad one when walking, this just sort of happened. I even managed to walk into town on the 31st for the anual New Year fireworks celebration, this was painful but on the heel sole where the neoprene seam of my boot is not on the actual tendon itself. Also on the same day I managed the holy grail of climbing and decending stairs with only puting one foot on each tread.

This is all excellent progress, but I have also started taking my boot off to wash my foot, and got a massive shock at the shape or “lack off” that my leg is in, it looks like a piece of string dangling down below me. While in this boot free condition I attempted the first few steps and it is a whole new phycological game (scary stuff).

I have managed (1st Jan 2014) to take a shower standing up bootless, so it’s all progress and I can basically put full weight on it now right through to where the consultant has it stopped (I believe thats 10 degrees off flat-foot), and even put presure onto the front of the boot (shin area) without any pain

My next appointment is tommorrow where I believe I’ll get the stop changed to allow up to flat-foot angle, and I’ll be making enquiries about driving and removing the boot for sleeping.

3 Comments »

First Few Steps

Posted on December 23rd, 2013 by Ross

Monday 23rd December 2013

At my first checkup - since getting into my boot, and the EWB protocol - my consultant had a good look at the achilles after my crutch slip incident. He seemed happy emough that there was no major damage “possibly pulled a few strands” was the official vertict. The main thing was he was happy enough to continue with his EWB protocol and as it was 4 weeks since my rupture he changed to boot settings to a 10 degree limit and told me I could start putting some weight on it. This was a bit worrying  (and painfull) but with the use of my crutches I could manage a few very tentative steps with my foot touching down.

The next day was a bit of a revalation. I’d spend a fair bit of time with my leg raised and  I felt like I could actually stand bearing me own weight without the crutches. What a massive phsycological boost. The biggest being the realisation that if I haddn’t canged consultants I would still have my full leg cast on.
I was going out to a frind’s Christmas dinner party that night and took the celebratory step of actually removing the boot (very carefully) to allow myself to put on some smart trousers instead of my baggy walking trouser. So this marked another first.

The next day I was feeling even better, managing to walk/limp along  with only one crutch. This is actually slower than using both critcues but is a massive mental boost, I can carry things again. I’m by no means walking propery as I can’t bring my good leg through forward of my recovering one but what a large and sudden improvement from crutching it everywhere, it is exactly 4 weeks after it ruptured and still before my first consultant would have removed my first full leg cast. I would still have had another four weeks in a lower leg cast to go with him.

I have so much to thank this website for, giving me the required knowledge and the inclination to be pushy enough to use that knowledge.

As my consultant had his speech bach he informed me that he studied in canada under another doctor who was using EWB protocols to treat ATR’s. and that previously he would always have suggested surgery to treat them but not now. He’s been treating ATR’s like this for 7 years now in Britain and has only had 2 re-ruptures out of about 40 treatments (5%), one of which the patient was substantially overweight. 

I’m almost beginning to think skiing in March might well be achievable after all. I’m starting to look forward to some physio already, I know it’ll be tough and painful but it’ll be worth it to get my leg back.

3 Comments »

Ecstasy and Agony

Posted on December 20th, 2013 by Ross

Tuesday 17th December 2013

My referal to the new consultant went well apart from the fact that he has larengitis and has lost his voice, so with a bit of mime, a tad of lip-reading and a good bit of scribbling he fitted me to the medi.Rom walker boot.
As speculated by others this boot is a “range of movement” boot which controls the amount of movement allowed by altering the hinge stops.  However it is only really the neoprene wrap that goes up your leg with a pair of splints at the sides. These splint are attached to the neoprene with velco straps going around your calf. The end result is that it seems to allow a slight up and down movement at the heel, something I think the VACOped might not allow with its full ridgid casing.

It was great to get my full length cast off, and I was amased by how stiff my knee was even after 3 weeks, but at least I can now bend my knee making everything from walking to getting into the car easier and less of a hassle.
This is good, it feels like real progress, the consultant tells me that my AT is healing and I sould keep the weight off my left leg for the next two weeks;  “toe-touch balancing only”.
I did notice that night that my leg (calf achilles etc) throbbed and hurt more than in the cast, I think this must be normal and comes with the slight movement it is allowed now. This will be well worth it to get fixed earlier.

Wednesday 18th December 2013

 As I’ve mentioned before in this blog I’m still going to work, getting a lift in and out with colleagues. Comming back home on Wednesday evening the ground was a bit wet and when I was walking through my front porch my left crutch (probably still damp)slipped on the poch tile floor. My instincts kicked in and I put my left foot down with all my weight landing on it. Due to the equine boot position my foot/ankle never straightened but my knee “locked” suddenly straightening my leg while putting weight down through my heal thus streaching the “healing” tendon. This hurt (a lot) and I think my kids learned some new words. My initial though was “I’ve re-ruptured it”. I’m  trying to compair the pain with the pain when it first happened. I’d say this recent event was more painfull, probably, but definately lasted longer (it throbbed all evening and I had to take some pain killers). I think I remember the original rupture not actually hurting that mcuh immediately afterwards. So I’m hoping  this is a good sign, i.e it’s still actually attached. I think the emotional pain of possibly setting myself back by three week is worse than the physical pain in my leg.

My next appointment with the consultant is only on Friday so I resolve not to worry too much until then, and let the proffessional look at it before worrying…………

It’s now Friday morning (20th) and I’m going to my appointmentthis afternoon. My leg has throbbed a lot since then, and my foot seems to have swollen since going into the boot, but I havn’t been keeping it as elevated since getting the boot. Maybe I should start doing that again?
From the feel and (little) foot power I seem to have I’m thinking  the Wednesday incident didn’t re-rupture the tendon (lets hope), but I’ll find out later.

2 Comments »

Changing Consultants

Posted on December 14th, 2013 by Ross

After finding a consultant who uses an Early Weight Bearing protocol, I  got my GP to refer me to him, the initial response wasn’t good the first free appointment he had for NHS patients was in February, (not much use for EWB). However my GP said she’d fax the consultant to see if he could fit me in. After a couple of phone calls to the GP’s secretary to make sure the fax had gone, I contacted the Consultants secretary to see how the referal was progressing.

Again initially not inspiring, whith her explaining how he was very busy and NHS patients wouldn’t be seen for a number of weeks. I once again explained the situation that I was now in a full leg cast for more than two weeks and looking for somebody who was willing to put me on an EWB protocol, that really should be happinging now, and that I knew the consultant was “trying” EWB for ATR’s. 
His secretary said she’d have a word with him and get back to me………

Littarally 5 minutes later she phoned back sying I was a very lucky chap. The consultant was impressed that I even new that he was treating ATRs with EWB, and said I’d already been in a cast too long. To that end he was willing to start his clinic early and fit me in at the beginning.

SO I now have a new consultant and will be getting my early weight bearing protocol, my appointment with him is on Tuesday (17th Dec) so only another couple of days wearing my Full leg Cast before being fitted into a medi.ROM Walker http://www.mediuk.co.uk/orthopaedics/anklewalkers/protectpneumatic-rom-and-fixed-walker.html
I know it s not the VACOped but I’ll talk to the consultant and see if he’d be willing to let me use a VACOped if I buy one, even if he doesn’t I’m still well chuffed to be moving onto an EWB protocol in week 3.

This should keep my target of getting onto skis in week 15 almost still in sight.  I’m so happy now. I’m looking forward to phoning up the RVI cancelling my appointment and discharging myself from their care.

4 Comments »

Confronting the Consultant

Posted on December 11th, 2013 by Ross

 

Mon 9th December 2013

I spent a bit of time on the internet collecting as much medical evidence for an Early Weight Bearing  protocol to confront my consultant with, this was mainly abstracts from the Bone & Joint Journal, but put together they made quite a strong argument for EWB.

On entering the consulting room I realised I was not seeing the main consultant but one of his “team”, who thought I’d been in my cast for 5 weeks?. I explained that I’d had had my cast on for only 2 weeks and was there to discuss the possibility of swapping my extreamly conservative protocol to an accelerated EWB one. He  listened to my point of view looked at the amassed evidence and said “It’s your tendon if thats how you want it treated I don’t see a problem”. He then went to check with the consultant.

“That was easy” was my first reaction…….. I should have known better. The consultant came to discuss it with me and explained that they weren’t prepaired to change my protocol because “that’s how we treat ATRs here”. On pushing him about buying my own VACOped, he stated that if that is what I wanted to do they’d cut my cast off, I could fit it myself and he’d refer me to a physio. Basically wash his hands of me, not a very proffesional approach for somebody with a “duty of care”.

So that was that, he’d given me his ultimatum and even suggested if I was going to do that to wait a full 4 weeks before cutting the cast off. I left saying I’d give it some thought.

Back to the GP.
My GP had always said I was entittled to a second opinion through the NHS, which now seems like my best option. The only issue is how to make sure I get a consultant who would be willing to give me an EWB protocol.
I tried a few different sources, a local private hospital (who do ATR reconstruction surgery), e-mailed a consultant who was involved in The Royal Devon & Exeter  EWB trial to see if they knew of someone locally, put a comment in the UK section on Achillesblog.com and contacted Oped-UK to see if they had information about who they sell the VACOped to in my area.

The advice I got back from both the blog and the R.D&E was to contact Oped, which I had already done via e-mail. Their local salesman contacted me with some extreamely useful information - apparantly if I lived 50 miles further South and walked into the James Cook Hospital in Middlesborough, I would have been put straight into a VACOped boot not even bothering with a cast! Talk about treatment lottery.

I also received another lead from a neighbour, working in the medical sector who showed me a protocol from a more local consultant who is using EWB with a medi.ROM walker. I googled this and it seems to be similar to the VACOped just made by a different manufacture, it looks a bit cheaper and less resiliant but if I can get onto an EWB protocol I don’t mind.

So I’ve phoned my GP back once more and asked to be refered to this local consultant for a second opinion.  I now await her reply as to how long my wait will be for the referal.

I can put up with this cast for a bit longer if I know I’m going onto an EWB protocol.

6 Comments »

Up to Date

Posted on December 4th, 2013 by Ross

 

With my last Posting (1 week on…) I have managed to bring my achilles blog up to date.

Everyrthing following shoul be more as and when it happens. The twitching, pulsing and throbing is still happening in my calf but I’m putting that down to the mending process.

I’m really hoping my consultant will listen to my request for an early weight-bearing protocol, because if he doesn’t I’ll have to go down the route of a second opinion, and knowing the NHS that won’t be a quick process. I know its another 5 days ’til my appointment but because I’m at work, it already feels like I’m half way through the week.
I think working is probably a good way of keeping your mind occupied and off the negative points of the ATR,  so I’m luck i can actuall do my job sitting down with my leg up.

2 Comments »

One week on…………

Posted on December 4th, 2013 by Ross

Monday 2nd December 2014

Having spend a full weekend in the house watching TV & surfing the web, I have been convinced that I need to something about trying to get onto an “early weight bearing” protocol. I tried phoning my consultant and managed to speak to his secretary. At first she was a bit stand-offish about the idea of me suggesting a different treatment for my ATR, but once I’d explained that I’m not pushing for surgery but an accelerated non-op protocol she seemed to be a bit more co-operative. I get the idea most people with this injury must try pushing for the surgery. She said she’d speak to my consyultant and get back to me. Which is exactly what she did.

The message from my consultant is that he uses the protocol I’m on as he’s “had good results from it in the past”, however he would be “willing to speak to me about it”. So I have booked another appointment (9th Dec) to see him. Co-incidentally that will be exactly 2 weeks since I went into a cast, so even following the accelerated early weight bearing protocol I’d still be doing the same up until that point anyway, albeit probably not in a full leg cast.
I am wondering to myself if he’s also “willing to listen” to me as well as “willing to talk to me” but that’s where I am at the moment, going back to my consultant to try and get him to change my protocol.  I consider this a small step in the right direction.

 To help me I’m trying to collect some of the evidence and protocals found in this website along with the articles I’ve been led to and some others I’ve found from the ‘Bone & Joint Journal’. I’ve even contacted the distributers of the VACOped boot in the UK  http://www.oped-uk.co.uk/oped-products/oped-vacoped.html to get a cost and delivery time ( £247 inc postage and VAT, next day delivery).

HELPFUL  TIPS

One week in and I’m starting to get used to my elbow crutches, easily managing to climb steps two at a time, sometime three if I’m feeling energetic. They still hurt the balls of my hands slightly after extended use, but that’s getting better as well.

One issue I have that may not apply to lots of you is reaching my toes, due to the full leg cast, which makes dressing a bit of a problem. My wife has solved this by buying me a “litter-picker”, basically a grab device on a stick. This make getting dressed a lot easier, same for my “limbo” (see earlier blog) pre shower.
As fo  showering a simple plastic stool  (designed to let kids reach the bathroom sink and toilet bowl) in the shower has allowed me to continue using the shower, lucky we have a 1200mmX800mm tray as I wouldn’t get my non-bendible leg in a smaller one.
I’ve taken a thermos flask an a rucksac into work which means I can carry coffee back to my desk, and I’ve started heating soup in the microwave for lunch instead of running out to the sandwich van.

So with a few basic modifications I’m still managing to go bout my life adequately (thank goodness for the lifts to work from colleagues) Although I’m obviously not doing any of the physical activities I used to do.

I did manage to hobble out for a meal with my wife and friends on Friday night, mainly by changing the venue to the hotel at the end of my road. This was fine but I did get a bit uncomfortable sitting with my leg down, and my toes were feeling rather swollen by the time I got home.

ACHES & PAINS

Apart from the initial rupture and the medical staff prodding and manipulating the first week has been relativley painless, I get a bit of numbness in my posterior and tingling in my leg but I’m putting that down to the immobility of the full cast. However Just recently (+ 1 week) especially in the evening I get a sustained throbbing in my calf  which increases when I stand up. It’s almost like my calf is trying to swell and the cast is preventing it, and if I’m vertical in the evening for too long the pain starts to bother me. To this end I’ve started taking a couple of ibuprofen in the evening  and this seems to came it down to allow me to sleep.

No Comments »

Back to Work

Posted on December 2nd, 2013 by Ross

Read more…

1 Comment »

The Fracture Clinic

Posted on December 1st, 2013 by Ross

 Monday 25th November 2014

The fracture clinic the next day was busy due to the weekend referals from A&E, and it was inevitable that my appointment was delayed. When I finally got to see the consultant he removed my backslab, spainfully queezed my calfs and pronounced I’d ruptured my achilles. He went on to explain that it could be treated by surgical or non-surgical means whith neither being that much better or quicker than the other, and what with the possible extra complications with surgey and the fact I wasn’t a professional sportsman that he was recommending the non-op method for me. Then explained that it was 4 weeks in a full leg cast followed by another 4 weeks in a below knee cast  and finally another 4 weeks in an air-cast boot. He did however want to check that the ends of my tendons were touching while in the rquine position, and was sending me for an ultrasound scan.
They couldn’t however fit me in for a scan until the next day and thus I was put into another backslab til then. This time however it was a full length one, immobilising my knee as well as my ankle and foot, making walking with my crutches even harder.

The plasterer also told me to buy a “limbo” to help with washing, which with hind sight is an excellent product http://www.limboproducts.co.uk/

That night I woke up a few times with pains and twinges in my bad leg, I think from lack of circulation and movement. On standing up I could feel the blood running back into my calf causing a dull throbbing - this didn’t bode well for a first night in plaster.

Tuesday 26th November 2014

First stop was back to the fracture clinic to get my backslab removed again, before hobbling to the ultra sound department. I wasn’t to worried about this scan afterall I’d seen it when my wife was pregnant, they smear on some gel and then painlessly move the probe over your skin…. I hadn’t realised they would want to do the painfull calf squeezing again and then even worse, they wanted to scan with my foot perpendicular.  As the pushed my foot up the pain was excruciating, probably no worse than the rupture itself but that was instantaneous whereas this was continuous agony.
Eventually they confirmed that the ends did indeed touch while my foot was “equine”, and I was sent away to get my permanent cast on.

It was while talking to the plasterer that I realised that ATR treatment was be no means a cut and dry proceedure, as  he explained that even within the hospital I was attending each consultant would treat ATRs differently. That was my first wake-up call that there may be other options to my treatment.

5 Comments »

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  • Recent Comments

  • Dikhsha | May 31st, 2021 | 3:34 pm

    Thanks for sharing useful content, I was looking for it.

  • janis | January 23rd, 2014 | 12:21 am

    Will do, Ron! I know it feels fine flat on the floor.

  • Ron | January 22nd, 2014 | 11:57 pm

    Hi Ross,

    Sounds good.

    I can’t wait to go skiing, but I assume that would require a lot of ankle and foot strength, and a lot of PF\DF, so be careful.

    JANIS, talk to your OS about slowly removing those wedges. I assume you started a 30 PF, and worked your way down to 20. Most people go down one every week or quicker, but check with your Ortho.

    At 8 weeks, I FWB and moving toward 2 shoes.

    Also realize that these guys are billable, and work at different hospitals, so the more they can see you, the better.

    Good luck
    Ron

  • Janis | January 22nd, 2014 | 6:35 pm

    How different our Ortho specialists must be!

    I’m coming up on my 8 week follow up tomorrow, and still in 20° elevation in the boot, and (supposed to be) using two crutches for pwb.

    Tomorrow, he’s supposed to tell me to cut back to one crutch - haven’t been using any for awhile now. Hoping to get my heel lowered too.

  • normofthenorth | January 21st, 2014 | 2:41 pm

    OK, the ski week was EIGHT weeks after my heart surgery! Heading for more coffee now, before I do any more math!

  • normofthenorth | January 21st, 2014 | 2:40 pm

    Good luck, Ross, keep going, and Watch Your Step!

    When I had a Whistler trip planned during my first ATR rehab (I’d already sent my wife alone to our first timeshare week), I discussed it with my “conservative” OS. (He’d already kept me in a cast an extra week because HE was in Aspen!!)

    He said “SURE you should go to Whistler in March! Bring some books, find a nice chair, get a drink back, and your wife will tell you about the skiing at the end of the day.” I booked the trip, initially without the 6-day lift package. The travel folks said I could add it in, with 3 days notice. So 3 days before takeoff, I put on “that” ski boot and snapped it into a ski after adjusting the heel release down to DIN 0, and pushed my knee forward and snapped out. Felt fine. Cranked it up a little and tried again, no problem. The 3rd or 4th time I was up around DIN 3-4 (vs. 7 on the other one), so I booked the lift tickets and skied.
    When I got back, I saw my OS again. I said “So I went to Whistler!” He said “And you walked and sat and did tourist things?” “No, I skiied.” “So you stayed on the blue groomed runs?” “No, I skied the ungroomed black r

    [...]
  • masons | January 12th, 2014 | 5:09 pm

    My right foot is in a cast. I simply drive with my left foot, and I haven’t found it to be too difficult at all.

  • Ron | January 11th, 2014 | 6:11 pm

    Looks like good progress so far. I remember how nervous and excited I was when I could take my first shower. LOL.

    Be careful about driving because insurance may not cover you if something happens and being able to take you boot off when you go to bed is awesome.

    Regarding driving, some on this blog have ordered special gear for their cars because their right foot was in a cast or boot.

    Good luck and let us know how that next appt. goes.
    Ron

  • normofthenorth | January 2nd, 2014 | 1:51 pm

    Sounds great, Ross! Don’t forget to Watch Your Step, and be especially careful on the shower. If you haven’t started doing gentle foot-wiggling exercises (seated bootless), you probably should. And PT could have started back at 2 wks in, too. Keep an eye on bit.ly/UWOProtocol and the Exeter protocol for guidance.

  • normofthenorth | December 24th, 2013 | 11:53 am

    SZ, I hope you’ve got a stool in the shower. Standing barefoot in a shower at 3 weeks sounds scary to me.

  • normofthenorth | December 24th, 2013 | 11:41 am

    That’s terrific Ross!! And that kind of patient empowerment is one of the best things this site ever does, and one of Dennis’s main goals when he set it up. And hurrah to Canada for improving British ATR care!! :-)

    Don’t stop, good luck, good healing, and Watch Your Step!

    When you do walk, PWB & FWB, make sure it’s as normal as possible in every way except stride length on “that” side. Never turn your toes out to the side, the way you probably did right after the injury. I think the best breakthrough is forgetting where you left the crutch or cane, and putting it in the basement — right up there with the big step when you realize you haven’t thought about this injury for a while (MONTHS from now)!

  • szaitz | December 23rd, 2013 | 11:29 am

    hey ross…congrats..hope you can ski soon.

    EWB, I assume is Early Weight Bearing. I wonder if that’s my protocol too, although I have never heard that term used by my Doctor or PT. I had surgery 3 weeks ago. Cast is off and I’m allowed to put my foot down when in the boot. I shower unbooted and both feet down.

    I have my 4th PT session today. I will ask him if I’m a EWBer, as I like the sound of that.

  • Ross | December 23rd, 2013 | 5:13 am

    Thanks Norm,
    The good news is at me check-up the consultant doesn’t think I’ve done any more damage, which is a massive relief, and I agree with you about the pain, I think I had a fairly painless actual rupture, short and sharp with little lingering pain.

  • normofthenorth | December 21st, 2013 | 4:20 pm

    Swelling is bad, elevation is good. Those Velcro straps should allow you to secure the boot so it’s protective — and later (PWB & FWB), so it will transfer your weight from the ball of your foot to the front of your shin. If you can’t accomplish that, the boot may be a bit too big. Wrapping another Velcro strap (my local dollar stores sell good ones) around the boot might help, or adding a flat footbed under your foot might raise your heel up to a narrow spot on the boot.
    Before you start walking, make a plan to build up your strong foot/shoe so it’s as high as your booted foot. That’s the only reliable way to walk PROPERLY in a boot, and walking badly risks a number of bad outcomes.
    I don’t think pain levels are a good diagnostic of ruptures, based on what I’ve experienced and what I’ve read here. Some people compare initial ATRs to childbirth, and many of us escaped with virtually no initial pain. All over the block, I have no idea why. But it makes me doubt that comparing your initial pain to your recent pain tells the tale, in either direction.

    Get it checked out. And watch out for wet crutch tips on smooth surfaces,

    [...]
  • jtarnopolski | December 14th, 2013 | 7:39 pm

    Had my surgery yesterday. It had been 4 weeks since I suffered a complete rupture and was worried that I would’ve had to go with the reconstructive surgery. Luckily, it was a clean tear and the tendon did not retreat into the calf muscle. The doctor said the tendon re-attached nicely and was an easy fix. Big sigh of relief and I have my first post op on Friday. The doctor did a great job. The meds have kept the pain at bay although I did get nauseous a couple of times. So now my recovery begins. I have 17 days off from my office job to give the tendon as much rest as possible.

  • normofthenorth | December 14th, 2013 | 3:35 pm

    And congrats on being an excellent Squeaky Wheel!! :-) A good GP is a precious asset, too.

  • normofthenorth | December 14th, 2013 | 3:33 pm

    It looks like a good hinged boot, similar to the one I have. Not space-age waterproof plastic like the Vaco, and wringing out the fabric liner would be too complicated, IMO. Also just one (rocker) sole, though I don’t really understand the function of the Vaco’s flatter sole (& it seems some users don’t either, or don’t love it?). I’d probably use it and save the $ — or £!

    I also had an AirCast which also has the air-bladders for a firmer more conforming fit, and I stopped using them. Good enough fit for me just with Velcro straps, and I found the plastic bladders hot and sticky for my taste — like a hospital bed with the plastic sheet under the bottom sheet. YMMV.

  • Hillie | December 14th, 2013 | 12:09 pm

    With my background in ICT and robotics, research has been an essential element in product development.

    However, I must confess here that my blog-posting has been mostly based on what I have experienced myself (as are many posts) or on findings from Exeter, Warwick, UWO, etc. Deeper research I haven’t had the time or the inclination to investigate and report. There are others who do this much better than I would.

    Within Achillesblog we have a good mix of personal experiences, based on advanced or archaic treatments, together with lots of theoretical stuff and research data. Just what a site like this should be and long may it continue in that spirit.

  • Hillie | December 14th, 2013 | 11:40 am

    Your new guy is probably quite switched on and it is therefore probable that his boot of choice is more than adequate. However, IF you have the nerve, ask Oped (VACO) if they are able to provide your consultant with a sample for evaluation, in your size of course.

    Some practices, including Exeter, recycle these boots when the patients have no further use for them, simply replacing the liners and certain other components, therefore continuing to save money compared to serial casting or even constant boot buying.

  • normofthenorth | December 14th, 2013 | 3:07 am

    Hillie, I think using a hinged boot is a sensible and helpful step between a fixed boot and 2 shoes. That’s why I resuscitated my old hinged boot at week 7 of my “otherwise strictly UWO” non-op rehab for my second ATR. But my reasonably careful analysis of the Exeter results, separating out the post-op from the non-op, suggests that their results — using a slightly faster protocol than UWO and a hinged boot instead of the AirCast — are probably no better than UWO’s. (Their post-op results do seem better than UWO’s, including zero reruptures in a big sample, IIRC.)

    The first days in 2 shoes are generally slow and scary, and it’s hard to scientifically compare HOW slow and scary, between hinged and non-hinged boot people.

    Everything you say sounds reasonable, but (a) I’ve seen many reasonable-sounding statements in ATR care DISproved when they were put to the test, and (b) the mechanisms you describe would certainly help explain a proven benefit of hinged boots AFTER that benefit had been proved. But they don’t substitute for that proof.

    I’m reminded of a Mensa party I once attended many years ago, when I briefly thought I’

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  • Hillie | December 13th, 2013 | 2:09 pm

    Norm

    Don’t you think that the hinged action helps the transition into 2 shoes?

    With a hinged increasing range of movement surely this helps to keep some strength and at least limited but controlled mobility in the bones and ligaments/tendons of the ankle, and even, to a small degree, the calf muscles. Going from a fixed boot into 2 shoes obviously does work well and on a similar time line to the hinged boot but is it as comfortable for the patient?

    With my thankfully limited experience, I don’t know the answer personally, it just seems to make sense.

    H

  • normofthenorth | December 13th, 2013 | 1:29 pm

    No time to check now, but most boots with “ROM” in their names are hinged. Wedges and hinges are interchangeable in the earliest stages when all rehabs have boot-hinges locked or “fixed”. Vaco and others start introducing limited hinge-ing pretty early. (I waited til 7 weeks post-non-op in my modified UWO rehab for ATR #2, which felt right to me.) The Exeter people went faster than UWO and used the hinging-ROM feature of the Vaco and got excellent results. But it isn’t clear that their non-op results were any better than UWO’s, with the fixed AirCast boot. Any reasonable boot should work well — and WAY better than any cast.

  • Hillie | December 12th, 2013 | 1:16 pm

    Hi Ross

    The medi rom walker seems to work with wedges, like the very popular Aircast boots which were, I think, used in the UWO trials, with great success. The Vaco boot adjusts the ROM through its hinge mechanism, and for the early days a deep wedge sole. Either make should be ok for you.

  • normofthenorth | December 12th, 2013 | 12:22 pm

    Good luck Ross, and keep up the good fight! I wish you could solve the problem for the next 100 patients too, but take care of your own leg first. Even if that Consultant insists on following “Eminence-Based Medicine” at least you’ve educated aome of his team, which may bear fruit.

  • Ron | December 8th, 2013 | 8:32 pm

    Hi Ross, that is normal and will subside. Regarding expediting your protocol, that is up to you. Keep in mind that wherever you are when you start PT, that’s where you will start. However, most of us have looked at various protocols and picked a course.

    Since you will have to do most of the work on your own, anyway, why not start now. In order to get to PWB or FWB, you must start your ROM work NOW. I started at 2 weeks and when PWB at 4, etc. Here is a link to my protocol with exercise links. It has a lot of protocols on it as well that you can view, print, etc. I also have a template, Norm’s favorite Protocol, etc.

    LINK: http://achillesblog.com/pgat2013/2013/11/04/here-is-my-conceptual-living-protocol-in-pdf-formatseeking-advice-word-template-avail/

    Good luck and Patient Move Forward.
    Ron

  • thelifechangingpop | December 4th, 2013 | 11:51 am

    Hi Ross, those calf twitches are somewhat unnerving, I think I had them for about the first 10 days. Hope your consultant is pro early weight bearing. Am going to be brave and introduce my surgeon to my Vacoped and my FWB self tomorrow, he’s expecting me on crutches! Go gently. Jen

  • normofthenorth | December 3rd, 2013 | 12:29 am

    Lots of us have used backpacks, fanny packs, mesh bags etc. to carry stuff. I finally found ONE travel mug that REALLY seals, so you can carry it any which way in a bag — and I’ve since LOST it! :-( But I still have the backpack with two mesh “slots” for travel mugs, that stay vertical as long as the pack is vertical. FWB is a huge relief after weeks of using these tricks!

  • normofthenorth | December 3rd, 2013 | 12:27 am

    Great, Ross. Almost everybody here who’s used those elbow crutches has said nice things about them. I’ve never tried them, and they’re (still) pretty rare here, and in North America, I think.

  • Ron | December 2nd, 2013 | 11:45 pm

    Hopefully, Norm, Kellygirl and many others will chime in here. They know a lot about the options.

    Good luck,
    Ron

  • Ross | December 2nd, 2013 | 5:17 am

    Thanks Norm, invaluable hints, however my crutches are the elbow hugging versions. I’ve never tried the full length ones but I’m getting quite used to mine now with no real issues. so I’m fairly happy with them.

  • Hopalong | December 1st, 2013 | 6:53 pm

    Hi Ross
    Welcome to my world! I’m at week 16 on the non op conservative route. Lots of reasons why I’m on this route, not least because I didn’t find this site until too late! It would appear that your surgeon has relatives all over the world!
    Norm, Jen and Stuart are right. Nothing wrong with going non op, but early rehab is the key. Don’t, and every subsequent stage just takes longer, putting you in the danger zone of rerupture for longer.
    Convincing a surgeon to change his protocol with what you have read off the intent is always going to be a tough call, so I would second Stuarts suggestion. However if you find yourself with no other choice, you could invest in a hacksaw and a Vacocast - As some others have done on this site!
    All the same, best of luck with it and take your time as you are laid up to trawl thru this site. It’s a gold mine!
    Cheers Hoppy

  • Stuart | December 1st, 2013 | 2:43 pm

    Norm is so right about torture with a full leg cast. It is ridiculous in this modern world to consider such immobilization necessary. I would not be able to take it and probably would have cut if off myself. As is was I screamed at the doc to put me in a boot after one week. Now if this doctor is quite old then he could have done his training in the 70’s with text books written in the 50’s from evidence gathered in the 30’s. I would find another doctor and get another opinion. As there has been no cutting then another doc will be more inclined to get involved. I don’t believe any damage has been done just yet by going this way as it is early days of treatment and the important thing is to get the collagen laid down around the injury.

  • Jen Deverson | December 1st, 2013 | 2:19 pm

    Hi Ross suspect your consultant is my surgeon’s cousin, ha ha. Unbelievable how many different approaches there are to “treating” ATR. My surgeon wanted me non weight bearing at 30 degrees for 6 weeks post op. I chose surgery as I hadn’t found this site and as a surgeon myself, albeit for cats and dogs, psychologically surgery was the option for me as I needed to know that those 2 tendon ends were nicely back together. Having now read all the multiple studies I think that if I had to “do a Norm” and rupture the other one (thank you Norm, your double rupture has been invaluable to all of us), I would go non surgical. I wasn’t brave enough to challenge my surgeon’s treatment plan so read as many of the ATR blogs that I could and all the associated info and then started on my own treatment plan. Am doing well, FWB in my Vacoped at end of week 5 and back to my clinic on a part time basis as from tomorrow. Follow up appointment with surgeon on Thursday, not quite sure whether I should crutch my way in or stride in in my Vacoped and see if I can enlighten him………
    Keep us posted as to what happens. Gentle healing. Jen

  • normofthenorth | December 1st, 2013 | 12:32 pm

    AARGH!! The good news is that a full cast would really hurt that evil incompetent consultant in a soft spot. Grrrr! What are they THINKING? What have they read, or heard?!? I’ve never heard or read a word even hinting that immobilizing the whole leg might have any benefit in ATR treatment, it’s just mindless torture.

    What you were told about op vs non-op is probably arou d average in 2013, though still a bit behind the best evidence. We used to hear that surgery was best for everybody who was fit enough to go through the op, though some other inactive geezers might like to skip the pain and the scar etc. That still persists in rare backward corners, long after the new randomized trials started showing equivalent strength, ROM, & rerupture rates.
    Now that several such trials and one meta-study have all confirmed that result (provided a fast modern rehab protocol is used, not old-fashioned “conservative casting” with multiple casts), the old mandatory-surgery story has almost died out. But it’s still rare to find a pro or elite athlete who goes non-op, so the op-pushers are now using that instead. Fortunately, there are a few

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  • normofthenorth | November 30th, 2013 | 3:45 pm

    Practicing on crutches helps, but making sure they’re properly adjusted helps even more. The top pads should NOT hit your armpits, but should be clamped between your upper arms and the sides of your chest. You should be able to straighten and lock your elbows while bearing your weight (though some strong-armed guys prefer not to). If your hands or wrists get beaten up or scraped, there are a number of ways to pad the crutches or yourself. Some people like gloves, but I always prefered to pad the crutches, so I lost the padding when I put the crutches down. Later, when the bottom of my foot was ultra-sensitive, I took the opposite approach and wore Crocs instead of carpeting the whole house with squishy gel. ;-)

    The cheap plastic foam pads they sell for camping was already one of my standard DIY raw materials and it worked great. Pipe wrap or other foam might be (almost?) as good for the crutches. All with some glue or tape to keep it in place. And the same stuff (flat) can transform a hard stepstool into a padded shower stool or a padded kneeling stool in front of a sink.

  • normofthenorth | November 29th, 2013 | 1:03 pm

    I’m still here, still addicted! Thanks for the nice intro, loumar! :-)

    BTW, going DAYS w/o think of your ATR at 29 weeks is impressive! I think I was celebrating MINUTES at that stage!

  • loumar747 | November 29th, 2013 | 12:23 pm

    Hi Ross - Sorry to have to welcome you to the blog but it is an absolute life saver. Your experience of the rupture is pretty much exactly the same as mine. As I too, looked to see who had thrown something at me, and upon realizing noone was there, quickly got the message. You will find a lot of terrific info on this site and, if you have any specific questions, I would suggest you contact ‘norm of the north’. He is a wealth of info. Also, all other members on the site will offer their best tips, they will commiserate, encourage and support.

    It does get better! The initial adjustment is probably the hardest. I am at week 29 and, while not functioning at my pre-injury status, am doing very well and can actually go for days now without thinking of my injury.

    Keep us posted! We’re rooting for you.