Six weeks and counting

Well, it has now been just over six weeks from the date of injury. Things are progressing fairly well. Now have the Vacocast set at 10 degrees, will speak to my Dr. sometime this week and hopefully move to 5 degrees this week and on to 0 degrees next week. Closely studying the various protocols I have, my aim is to be at 0 degrees (eqv of no wedges) by eight weeks as most seem to call for.

Continuing to do physio twice a week, PT says we will be starting something new this week (I see him tomorrow). Up to this point it has just been seated calf raises with electrical stimulation and instructions to work on the same at home with soft stretching.

Started showering without the boot on a few weeks ago, a little scary to stand on the leg but good progress. Also started sleeping without it at week 5, first few nights I woke up every time I moved for fear of dorsiflexion, LOL! Actually hobbled from the bed to the bathroom the other morning sans boot, felt very weird, not much foot control, LOL. I started driving again this week, nice to not have to depend on my wife and co-workers to get around.

I have progressed my gym workouts to biking and elliptical machines, both are relatively easy to do in the boot. Also started single leg extensions/presses/curls/calf presses with the good leg.

Slow but sure! Hope everyone is enjoying the last few weeks of summer!

20 Comments so far

  1. normofthenorth on August 19th, 2013

    “Slow but sure” is an oxymoron re non-op ATR cure, accd to the evidence. UWO gets to neutral (no wedges) at 6 weeks, and I can’t recall any good modern studies taking 8. UWO does 2 shoes (0 wedges) at 8 wks. And the latest documented study (see suddsy’s blog) went a week or 2 faster and got BETTER results including LOWER RERUPTURE RATES! “Fast but sure!”

  2. hillie on August 19th, 2013

    Hi Seaweed

    The Exeter hospital based study that I posted on Suddsy’s blog used the Vaco boot too. At 6 weeks my boot was set to a hinged range of movement from 30º PF to 0 (neutral). Coming up to week 9 it was the move into 2 shoes indoors with one more week prescribed for the boot outdoors, although in reality if on a good flat outdoor surface 2 shoes worked ok for me.

    So, the move to 2 shoes is pretty much the same for UWO as for Exeter, the key to Exeter’s success being the move to FWB in week 3 while weaning off the (elbow) crutches. During week 3 and 4, the boot had the thicker wedge sole fitted, and the boot was fixed at 30º PF. I had even bought a knee trolley - a waste of money for what turned out to be just a few days use. Just keep the hips level and avoid stressing the good side.

    Physiotherapy started at week 3 with light flexing (PF only) and ‘alphabet toes’ and at week 4 I was using a theraband (although down in the protocol for week 6, showing that even a fast protocol like this had scope for improvement if you’re up for it).

    The rerupture rates quoted by Exeter were very low indeed whether surgical cases or non-op - the hospital used the same protocol for both treatments. I was non-op so I also didn’t have the after effects of surgery. 18 months later I am walking harder and faster than for many years - I’ve been sticking to the big hills, now for the mountains again.

    Worth mentioning that because the final adjustment of my boot allowed movement between 30º PF and 10º DF, the move into 2 shoes was a non-event, simply no problem. Some ATR guys have found this to be a difficult stage. It is mostly about early mobility - less calf atrophy and stiffness of ankle, and increased strength. Therefore more security and confidence, and definitely ‘feeling good’ sooner.

  3. hillie on August 19th, 2013

    For those in the early stages of recovery, I should emphasise that week 3 was FWB as tolerable - don’t expect to immediately put all of your weight on the leg all of the time. Start off with short distances and increase as you feel able - but I’m talking days that’s all, and by the end of week 4 and the change to the flatter sole and some ROM, was no problem at all.

  4. seaweed on August 19th, 2013

    Thanks for the comments guys…yeah, all of the protocols I have read suggest that at six weeks you move towards 0 degrees/no wedges in the boot, they just seem to vary how fast you get there. I have seen nothing that says you should be going flat prior to six weeks. The PT protocol I have from the clinic here suggests removing wedges one at a time starting week six, the Vaco protocol seems to suggest going from 15-30 to 0-30 flexion overnight at week six…I am doing a more gradual approach, starting week 3 have gone 30-30-15-10, plan to go 5-0 this/next week, so I will still be flat by the start of week 8 the way I am doing it.

  5. hillie on August 19th, 2013

    It is true that with Exeter’s protocol patients have 15º movement one day, then straight to 30º. It felt odd for an hour maximum in my case and I did take it steady for a day or two. I followed the protocol, did the physio exercises, it all worked. I was in the right place at the right time and it is still frustrating to me that any orthopod in the world can read the findings of the Exeter, UWO, and other research and studies, then take no notice.

  6. chris90 on August 19th, 2013

    Seaweed, I hope to be where you are this weekend. I ruptured mine 2 days after you but due to the NHS forgetting to put the right wedges in I am going to ask to go into shoes on Friday when I visit the physio. I haven’t suffered any pain or discomfort in the tendon since I went FWB after a week going into the boot and I e been doing the Theraband exercises which feel good.

  7. normofthenorth on August 19th, 2013

    There’s nothing wrong with going gradually (”incrementally”) toward neutral. UWO did well with a sudden jump from 2cm of wedges to zero, but it felt too sudden to me (partly because I’d accidentally gotten 3cm of wedges, not 2). So I spread it out over another day or two.

    The size of a hinged boot’s “swing” isn’t a very meaningful measure here, IMHO. When I was in a hinged boot (after BOTH of my ATRs), I don’t think the boot-hinge was limited in PF at all, not at 30º, not 45º. . . My PF was limited by my ankle’s ROM, same as in shoes. ATR patients aren’t expecially susceptible to harm from excessive PF, so I don’t think that limit is very important.

    But the change in DORSIflex limit is vital to a healing AT, for obvious reasons. I’ve often opined that any change toward neutral should preferably be made at bedtime before sleeping in the boot, to separate the “stretch” from the “load”. I also believe that prompt listen-to-your-body feedback from a leg is a good guide to the timing of the stretch. Almost everybody here who got shifted toward neutral early or in a huge jump felt discomfort or pain. And almost everybody here who got shifted toward neutral unusually late felt relief! We can’t count on that level of prompt feedback all along the way, but it seems to work well for the transition from equinus to neutral.

  8. normofthenorth on August 19th, 2013

    Hillie, about your “it is still frustrating to me that any orthopod in the world can read the findings of the Exeter, UWO, and other research and studies, then take no notice.”

    I think you should cheer up: I’m sure the vast majority of the dumb old-fashioned doctors who prescribe dumb old-fashioned ATR protocols (or who make false claims about op vs. non-op) have NOT read the studies at all! :-)

  9. chris90 on August 19th, 2013

    Norm, what are thoughts on the now wedge situation I find myself in? I hope my physio can explain any complications I might face but as I said, I don’t feel any pain or discomfort and I’ve only had the little wedges in the boot that go into you trainers at the end.

  10. hillie on August 19th, 2013

    Norm, you’re right. Frustrating is perhaps too strong a word when none of this physically affects me any more - but you get what I mean. In any case, over the past year or so I have been almost equally amazed at how many patients are accepting of their situation despite being in undue pain or cast for ‘too’ long or no therapy exercises or no washing that leg and foot or loads of other things.

    Despite this blog, which has helped probably hundreds of patients to recover quicker or more sanely, many others, despite what they learn here, don’t ask questions, don’t take UWO or other protocol info with them to appointments.

    Must stop visiting here - seems to be addictive!

  11. seaweed on August 20th, 2013

    Hey Chris, I hope all goes well on the weekend with the Dr visit. So you went right into a boot 2 days after injury with no wedges? Like you said, probably not a problem for weight bearing (I had no pain either) but I would think there might be a risk of “healing long” as I think the strong PF angle in the first few weeks is designed to limit the length of the re-annealing tendon with gradual stretching as the weeks go on. My apt went well today, I have almost full range of motion both DF and PF…after talking to Dr I changed my boot to 5 degrees and will change to 0 next week. Theraband exercise for the next two weeks then the PT says we will start exercise cycle without the boot!

  12. superjewgrl on August 22nd, 2013

    Wow! Your driving. Do you drive with the boot? I injured my right foot also, but didn’t anticipate driving until I was in 2 shoes.

    Great job on your progress.

    Happy healing!

  13. seaweed on August 22nd, 2013

    Hi SJG, thanks for the well wishes…glad to see you back posting. Yeah, I slip the hard parts of the Vacocast off and simply drive with the liner on. Once I started doing seated heel raises and Theraband exercises I was pretty sure I had the strength to push the accelerator down, so about a week ago (six weeks post ATR)I took a careful drive around the neighborhood and found it not too difficult at all. I use my heel on the brake pedal and push with my leg, but other than that is seems ok. How is your recovery from surgery going?

  14. superjewgrl on August 22nd, 2013

    Well I may take a page out of your rule book on the driving. I am not sure how I deleted my blog but oh well. My healing is good, I get my cast changed tomorrow and thus we talk about the vacoboot and PT so I’ve decided to bring the doctor baked goods to have him more receptive to my wishes. :)
    Do you drive an automatic or a stick? I drive a stick, but hopefully I’ll be able to manage. So you are are weeks ahead of me and I’m still in captivity. :(
    Take Care. Keep us posted. Thanks for the info. xx

  15. seaweed on August 22nd, 2013

    Glad to hear your recovery is progressing well. LOL at bribing the Dr with treats, I just showed up with the Vacocast and told him I had researched on the internet and was using this. I drive an automatic so likely a little easier as only one pedal at a time to worry about. Once you start doing some band stretching and seated leg lifts I suspect your flexion will be strong enough to operate the pedal. Don’t despair, once you get in the Vaco you will be up and about in no time, and no wedges to slip this time :-)

  16. sammiej6 on August 28th, 2013

    Seaweed - I cant believe that I am at the same week as you when you wrote this post - 6 weeks since injury and I am still in a non-weight bearing cast!!! I don’t know what to do as been told I need to wait four weeks if I want to see a different consultant for a second opinion and I cant afford to go private. Its starting to get depressing!! The only thing I can really do is demand to be put in a boot when I go back to my appointment next week which will be 7 weeks in a non-weight bearing cast.

    Was yours a full rupture?? When was you removed from the cast and put into the boot?

  17. seaweed on August 29th, 2013

    Hey sammiej6. Sorry to hear that your Dr seems to be sending you down what sounds like an “old school” protocol. Almost everything I have read on here (and based on the latest peer-reviewed journal results as shared by normofthenorth, sudsy, hillie and others) suggest that early weight bearing and controlled mobility gives the best results, esp if you are going the non-op route.

    I believe I was a full rupture…failed Thompson test, ultrasound showed tearing but could not “see” separated ends, but OS said he thought he could feel the ends.

    I was in a full plantarflexion plaster cast for two weeks, NWB…then into Vacocast and started PWB, progressing to FWB at week 5. Every week I moved the flexion setting 5 degrees, so I went 30-20-15-10-5-0 through weeks 3-8, similar to what is shown in the Exeter study but with graduated changes instead of milestone larger ones.

  18. jay edwards on September 7th, 2013

    thank god for this site. .im at 5 wks. fwb no crutches.boot outside only.walking around house.start pt next wk. im at neutral but ive had to push for it.and i prey alot ..i take 2 table spoons of geleton a day no achole no caffine.

  19. jay edwards on September 7th, 2013

    oh yesh,im 68yrs old.i tell them what i want. they probaly figure,”whatever” and say ok.im going to the gym and trying to do things right.one thing ive learned in 68yrs.everyone is diff.especially doctors.

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