So last wednesday I had my post op check 2 weeks after my surgery - the stitches were taken out from either end of the incision (apparently they were attached to absorbable sutures underneath the skin!) and my wound looked good. I was now allowed to shower and get my leg wet for the first time in 2 weeks which I was excited about.

The surgeon then passed me onto the physio, where I was fitted into a boot. The physio sees lots of ATRs as they work with a foot and ankle surgeon in the same building. While i was waiting for my appointment i saw two other guys with casts on waiting for the same thing as me! However, because of this, the physio usually follows the ATR protocol by the other surgeon : Partial weight bearing (up to 30 kg) in Achilles boot with 30° wedge for next 3 weeks. Weight bearing as tolerated in Achilles boot with 20° wedge for next 3 weeks. Weight bearing in shoes with 2 cm heel rise for next 6 weeks. This was different to and a little less aggressive than the UWO protocol my surgeon had given me.

They also recommended that I don’t start any ROM exercises till 5w post op, as they are worried about the tendon healing long. Obviously if the tendon is stiff you can stretch it out, but if it is too long there is nothing much you can do to fix this except another surgery to shorten it. Although I do worry about healing long, I’m thinking if i follow the UWO protocol and not dorsiflex the ankle past neutral I don’t see how I can overstretch it as there is still that 15 or so degrees of dorsiflexion that I woudln’t have used.

I decided I was going to follow the UWO protocol myself for now then start formal physio in another 2 weeks. Started partial weight bearing which has been great as it makes it easier to balance, makes it easier for my arms to cope and makes me feel that I am moving closer to full recovery! I went home and measured my heel lifts carefully, and removed one of the lifts to make it 2cm. It actually felt more comfortable with 3 at this stage, probably as my tendon was still a bit stiff, so I left 3 heel lifts in that day and started ROM exercises to loosen my tendon a bit. By the next night, I removed a heel lift before bed and it has felt comfortable and easier to walk since.

The UWO protocol I have does not state how many reps and how often I am meant to do my exercises - so from looking at other protocols I have decided to do around 10-20 reps 3x daily of dorsiflexion and plantarflexion (not past neutral), decreasing the ROM if there is pain. I do the same for inversion and eversion. Leg lifts lying on my back and side, about 20 reps at least once daily, and then situps and pushups to try and keep a tiny bit of general fitness up! Does anyone have ideas on how many reps and how often I should be doing ROM exercises at 2-4 weeks post op?

The swelling in the leg is causing much less discomfort these days, no throbbing feeling when getting up. Along with PWB, this has been great as I have now been able to get out of the house and go out to visit friends and eat out - I guess the thing with the ATR is it has made me take a step back and appreciate all the simple things in life! The ankle still swells and becomes uncomfortable when I sit down and don’t elevate the leg for a few hours, but quickly goes away once elevated. I am assuming it will continue to improve as the days and weeks go by. Can’t wait for another week and a bit when I can start increasing my weight bearing to be FWB in the boot (at 4w post op!)