Filed Under (Uncategorized) by starry on 19-06-2011

8w post op and my protocol is to wean off the boot, which allowed me to do two things which I had missed so much!!!

1. Showering standing up instead of sitting in a chair in the bath tub holding one of those shower hoses. Oh my god words cannot explain how good it felt to feel warm running water on my back. Similar to the feeling when I’ve gone camping for a week and had my first shower at home after, but much much better!

2. Sleeping without the boot on. The feeling of your foot moving around between the soft sheets, and no boot to get caught on the quilt when you need to move - heaven. AT does feel a bit stiff in the mornings as it stays roughly in plantarflexion while I sleep, so I have to be careful to dorsiflex it a bit in the air before I step out of bed, but who cares it feels so good.

This got me thinking about all the other milestones earlier in the AT recovery, all the little achievements that made me so excited that I would jump up and down cheering if it weren’t for the AT!

The first time the cast comes off and you can finally scrub the dead skin off (gross) and get rid of the smell, and finally itch your leg without trying to poke your finger down the top of the cast.

Walking in the boot with only one crutch and able to carry something in my other hand. Usually to feed myself or enjoy a cup of tea. Being able to make that cup of tea without assistance was nice too.

FWB in the boot and not having to use crutches, what a feeling of freedom for the arms and hands, made it so much easier to do all the day to day things like cooking and even buying groceries. It was hard trying to shop with crutches, there were only a limited number of items I could carry while holding the crutches too. Although I did think about carrying a backpack and putting things in, but didn’t end up trying it as I thought they might think I was shoplifting.

Standing on two feet without the boot, then being able to walk without it, even though the walk is a limp and ridiculously slow that it makes you want to put the boot back on for convinience. Also realising that your heel isn’t used to uneven surfaces that walking on a rug feels like you are walking on glass shards, but again who cares, you’re walking on two feet!

I am still waiting to drive my manual car, left ATR and my clutch is heavy so I’m waiting for more calf strength to return before i try it, but I think that will be another "moment" in the ATR recovery! Anyone who’s back driving manual got any advice on when postop the clutch felt comfortable, and any tips?

Oh and I’m finally back to work full time working up to 10 hour shifts half on my feet half sitting, and the AT is holding up well with the boot. Still aches a bit at the end of the day but recovers once I elevate and ice. Another milestone, but not necessarily one I am celebrating!


normofthenorth on 19 June, 2011 at 4:03 pm #

I still remember every one of those milestones, Starry! (At least from my second ATR; the other side, from 2001, is starting to blur. . .)

Nick9671 on 19 June, 2011 at 11:46 pm #

It is funny how excited we get about such small things we took for granted before ATR. I just got my cast off last week and am PWB in boot, I was so happy to get that cast off. I will be even happier to ditch the crutches. I still feel like I am a long ways from putting my weight on my bad foot to walk. I am almost 4 weeks post op, did you feel this way when you started putting a little weight on it with the boot? It feels so tight like that tendon is going to pop anytime. Dr wants me off the crutches and FWB within a week and I don’t know if thats going to be possible. Would like to hear how that stage went for you during that transition to NWB to FWB. Thanks,


normofthenorth on 21 June, 2011 at 1:36 pm #

I started PWB on crutches at 2 weeks, initially with ZERO weight, but letting the foot “walk” as I crutched along. By 4 weeks, I was cleared for “FWB as tolerated”. I went from almost FWB to fully FWB in around 3 days. (I knew I was there when I started forgetting where I’d left the cane! :-) )

I’m not sure I ever felt like I wouldn’t ever be able to do FWB, but I did suffer from the bottom-of-the-foot sensitivity (esp. heel) that almost everybody complains about. Somebody recently commented that subtle textures like carpet felt like broken glass, and that was pretty close for me. (You’d think all the layers of dead skin would make us INsensitive, but NOOOOO!)

Once you master FWB standing, it won’t be long before you’re using the boot to walk fast. Even stairs are relatively easy once you learn the tricks — esp. the trick of going DOWN stairs in a boot.

normofthenorth on 21 June, 2011 at 1:38 pm #

OK, all of that last post was @ Nick, and the “Somebody” I referred to is Starry, the host/OP of this very page! (Oops!)

starry on 22 June, 2011 at 1:51 pm #

I had the same protocol as norm so was PWB from 2 weeks then FWB about 4-5 weeks - took me close to the 5 week mark to reach FWB as my AT would ache after walking on it too much with 1 crutch or even short distances FWB. I started off with 3 heel lifts in my aircast boot at 2 weeks post op but moved to 2 heel lifts a few days later - at first when I tried 2 heel lifts at 2 weeks post op the tendon did feel really tight hence the 3 lifts.
Are you in a boot, and have you got any heel lifts/angle of boot adjusted to raise the heel and decrease the stretch on the AT? Do you feel the tight tendon sensation even without weight bearing? And are you doing gentle ROM exercises yet or no?
Like I reported in my blog I’ve felt aches and twinges in my AT but can’t remember feeling like it was so tight it was close to snapping… if you are concerned maybe you should talk to your surgeon!!

Nick on 23 June, 2011 at 8:35 am #

I think the reason for so much tightness is bc I went from the cast which was slightly angled to a full 90 in the boot with no wedges. I asked the surgeon about wedges and he basically called me a wuss and said it would be fine to stretch it to 90. Now that it has been a few days since my post above my tendon has gotten used to the stretch and I am walking everywhere in the boot. Man the first couple days after he put me in the boot, I felt severe tightness and pain as it got used to the stretch. Maybe you should just take all your wedges out and try with none. My tendon seemed to get used to it fairly quickly.


normofthenorth on 23 June, 2011 at 2:33 pm #

Nick, I don’t see any advantage to throwing such a sudden stretch at your AT and calf. It is true that my fave protocol (bit.ly/UWOProtocol ) keeps both heel wedges in the boot for 6 weeks, then takes them out, apparently “cold turkey”. But I found that very abrupt, so I took them out one at a time over the course of a couple of days. Doing a big stretch when you’re NWB is one thing, too, but doing it while you’re FWB sounds scary to me. (Removing a wedge at bed-time helps, if you’re still sleeping booted, ’cause it separates the stretch from the loading.)

Especially since the most common bad clinical outcomes are variations on “healing long” (=~ over-stretching), it seems wrong to go all matcho in that arena.

Nick9671 on 23 June, 2011 at 10:47 pm #

Well after the pain that first couple days getting used to the stretch I would have much rather had wedges if I had to do it over again. I was still NWB after he put me in the boot for a few days. Then went PWB for a couple days til I felt comfortable going without the crutches. What happens if your tendon heals long? Is this something I should be concerned about? It has only been stretched to 90, not any further. Thanks for the info.

dan on 4 July, 2011 at 3:48 am #

Hey im 8 weeks right now. I got the cast off at 6 and the doc told me to start walking on it. Im not at 0 degrees dorsiflex yet and im wondering if this is normal? i feel this is the main thing affecting me walking right. im tired of gimping around

Stuart on 4 July, 2011 at 6:12 am #

2 weeks ago I would have said that I couldn’t get to 0 degrees. Now at 10 weeks I can stretch it to 0 but it is still feels tight. I’m due to drop a wedge out of my shoe today. Progress is slow but thanks Dan for reminding me there is some.

starry on 4 July, 2011 at 2:01 pm #

Nick - if the tendon heals long the only way to really fix it is another surgery to make it shorter. But I woudln’t really worry if I was you since like you said, you’re only at neutral not beyond.

Dan - Walking in 2 shoes or just in a boot? I reached neutral at 6 weeks, but this was after having the splint off at 2 weeks and doing gentle ROM exercises for the 4 weeks after - so it does take some time to gain that ROM back. Since you’ve only been out of the cast 2 weeks I’m guessing you just need more time and exercises to help get the dorsiflexion back.

Stuart on 4 July, 2011 at 5:53 pm #

My physio did a tendon update course on the weekend but said there was not much new in it for her but over the session I managed to gleam some stuff. Apparently one of the speakers was the private Physio to Harry Kewell (international and Australian soccer player)and before the world cup last year. She said that the message was not to be in too much of a hurry to get the wedges out once in 2 shoes. Once you can walk normally without it feeling tight then it is time. I am keeping mine in for a bit longer.

normofthenorth on 5 July, 2011 at 5:58 am #

Stuart, I feel the same way about getting the wedges out in the boot! Hardly anybody has trouble regaining dorsi-ROM, and lots of people experience discomfort or pain when moving toward neutral in casts or boots.
My fave (”UWO”) protocol keeps the same plantarflex angle for 6 whole weeks, then goes “cold turkey” to neutral (which I found too abrupt, so I spread it out a bit). I haven’t seen any evidence that going to neutral sooner is better, unlike early WB and early exercise/motion. . .

UWO actually did NOT use wedges in shoes. Most of us just shorten our asymmetrical 2-shoe stride to limit our FWB unprotected dorsiflexion. I’ve usually considered wedges in 2 shoes to be as much for convenience as for safety.

Stuart on 5 July, 2011 at 6:19 am #

I’m with you. Trying to stretch the guts out of this before its ready just to get some dorsiflexion is insane to me. I know there are so many different ideas, (We have been through this before) but for me, walking normally and reasonably fast without a limp while I have the wedges in and then the short stilted gait I have with them out, there is no comparison. By the end of a big day things get a bit overloaded and I falter a little. I also know that limping around puts unnecessary stress on other parts of your body.

Stuart on 5 July, 2011 at 6:21 am #

P.S. Norm,
I posted some info for you on MTBriders page. Not sure if you saw it.

normofthenorth on 6 July, 2011 at 3:06 pm #

Stuart, I had missed your info on the other page, thanks.
Maybe I would have loved, and benefited from, having heel wedges when I first went to 2 shoes, hard to tell now. I do believe that “there’s limping and there’s limping”. Lots of limping accommodations get our bodies into bad habits and put excessive and abnormal loads on certain body parts. Walking with one leg out the side is certainly one of those, IMHO.
But I don’t think that walking with a shorter stride on one side is one of them. Shorter, yes, “stilted”, yes I suppose so. I also don’t think I spent long with an asymmetrical short-one-side stride, because I gradually but relatively quickly built up the dorsiflexion (and stability/strength) I needed to walk normally — except for the little “dip” at one end of the stride, when the recovering calf-and-AT SHOULD have pushed off and propelled me forward, but could not. The heel wedges don’t eliminate that “dip”, do they?

And isn’t there a corresponding and offsetting deficit at the opposite end of the stride, from the wedges? Seems offhand that there should be an offset. . .

parisgirl78 on 9 August, 2011 at 11:36 am #

I’m curious as to where people start feeling aches in their tendon’s when they start putting weight on it. I’m 6 weeks post op & PWB and feel a little tightness below my calf but above my incession, could this be the tendon? Is it normal to feel this?

oscillot on 25 June, 2015 at 6:17 pm #

These milestones would be a good alternate beginning to the ATR Marathon. Sports, or an actual marathon, are my mile 26.2!

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