Last Wedge came out….

Hi all,

my last heel wedge came out on Monday and it hasn’t been too bad. Still doing the same ROM movements but also been standing for periods of time with my feet together out of the boot to really give the tendon a stretch. My physio is really really careful and doesn’t want me to walk at all without my boot even though it’s 8 weeks today since the injury. I have taken a few little steps just to get about my bedroom if crutches are not about but I have put all my weight on my heel. I have tried to press the ball of my foot onto the ground but it feels so week I can hardly feel any tension at all………I now have the boot until the 30th when I start to wean off.

8 Responses to “Last Wedge came out….”

  1. I’ve been heel walking out of the boot too, moving forward onto the ball of the foot I am just too scread to try …. like you said, it just feels like there’s nothing there and I scre myself into thinking it’s tempting fate :(

    Does your boot allow you to push onto the ball of the foot as you walk?…. I think it’s possible to use the support of the boot to help re-learn that.

  2. I found it much harder to push on the ball of my foot in the boot than in shoes. It always seemed “uphill.” After I finished riding the stationary bike in the earlier weeks, I did a few careful walks back and forth in shoes before putting the boot back on and it seemed easier since it was warmed up. I’ve been in shoes for almost a week now, and it gets easier every day - just from repetition. I still have to consciously choose to go “heel to ball of foot,” but it’s not as scary since I’m not feeling those big pulls on the AT anymore. (just little ones)

    Andrew - just shift your weight to the ball of your foot for now, then in a few days or a week try to push off. Calf exercises are really helping me feel more confident and stronger for that.

  3. Andrew-
    To start out, I didn’t worry about pushing with the ball of my foot; I just worked on the rolling motion. Just make sure that the first thing to leave the ground is your heel, and the last thing to leave the ground is the tip of your toes. Do that, and after a while, the push will start to come naturally.

  4. Hi,
    thanks for all of these tips guys. I will practice even though the physio has told me to wait I feel I do a wee wee bit a day at a time……

  5. Sheena, I think you should avoid going slower than bit.ly/UWOProtocol , because it seems to make the outcomes worse (on average), as well as being more of a nuisance. Print out the protocol and/or the study, and share them with your PT. I’m a blunt guy (obviously), so I’d just ask the PT if his/her non-op results are as good as UWO got with their protocol. Many people are too polite for that, but see if you can get the point across using your own style.
    There’s obviously a risk from going TOO fast at 8-ish weeks, but UWO’s speed doesn’t seem to be too fast. And the old “conservative casting” studies show very clearly that there’s a serious risk from going too slow, for non-op patients. Don’t Go There!

    People are comparing their experience with boot-walking, without mentioning (a) if they’ve got a fixed or hinged boot and (b) if it’s hinged, how far can it dorsiflex? These are crucial variables, like apples and oranges, IMO.

    Assuming the boot is either fixed or hinged But Not Past Neutral, you should certainly be able to follow Ryan’s approach. Heel to toe, off you go. Initially, all the force holding up your weight when you’re on the “ball” of the boot comes from the top front of the boot pressing into your shin. As you get stronger and more comfy, you can “PWB” it — i.e., gradually transfer more and more of that weight to your calf and AT. There’s no big leap needed, just push as hard as seems comfortable. If you stay in a hinged boot way too long (or strengthen WAY faster than most), you could take ALL that weight with your calf and AT. But it’s a gradual, “as tolerated” thing while you’re in the boot.

    When you’re out of the boot, the “as tolerated” gradual thing becomes how short your stride is on that side. If you’re trying to walk fast with long strides, it’s a question of how much you limp, since your stride on the other side will be normally long.

    Kimjax, I’m puzzled by your “I found it much harder to push on the ball of my foot in the boot than in shoes. It always seemed “uphill.” ” I know exactly what you mean, clear as a bell, but I’m trying to figure out how the boot could be set up (badly! :-) ) to cause that to happen.

    Was it hinged? To neutral? Did you have heel wedges in your shoes? Maybe that’s one answer: if it was more dorsiflexed (or could hinge-move to more dorsiflexed) than your shoes, then I think you’d have the problem you so clearly describe.

    Whether or not to use heel wedges in shoes — usually after getting to neutral in a cast or boot — is still a big divide in ATR Rehab. UWO didn’t, so I assume it doesn’t help, but that’s a leap, not based on direct evidence.

  6. Dear Norm, fwiw, imho, wedges can and do work. I used silicon wedges in first week of ‘2 shoes’ and also some weeks earlier under my good heel when it was hurting (PT’s recommendation). My protocol is very similar to UWO, at least as quick, and with a tweak or two e.g. the silicon wedges. My boot, as I’ve mentioned before, is a VacoPed Pro, adjusted fortnightly and finished with at 9-10 weeks. Perhaps it’s the squidge in the silicon that makes it work so well.

  7. Hey norm - I had no problem walking in the large sole of the Vaco, but had a hard time walking with the flatter sole. I had it hinged from -5 to +10 (doc’s restriction) on the lower sole - fixed with the big rocker sole. I couldn’t walk in my other traditional hinged boot at all. I did push my shin into the boot like you recommended, but my limited DF kept me from really rolling forward and sometimes I rocked back almost hyperextending my knee. The large sole rolled easily so I just stuck with it.

    My shoes work well for transferring forward when I purpose to do it - but it might be that my calf is just getting stronger with walking and seated calf raises. It makes it less scary to roll onto the ball of my foot. :)

  8. Hi Norm,
    I am walking just like you describe in my Aircast non hinged boot, that’s not the problem. I was FWB with the boot from day one of getting it. I’m talking about walking without shoes really. My physio wants me out of the boot on the 30th which will be the start of week ten but I feel I can do a little bit of walking now really but what I have done has all been off my heel. I know the UWO weans off the boot from 8 weeks. I have no heel lift in my boot and it is fine. What are your thoughts about walking now even though the physio has said not to but that’s because my doc’s protocol is ten weeks to two shoes.I obviously don’t want to re rupture. I was 8 weeks yesterday.

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