End of Wk 2 - Wow, progress!
Uncategorized June 24th, 2013Taxied into central London for my 2 week post op consultation…and it was all very encouraging.
I’ve been in splint with my foot well elevated for pretty much all the post op period, and being well-behaved appears to have paid off so far. After the nurse took the stitches out of the neat 2 inch horizontal cut across my Achilles, the surgeon came up for a look. It is apparently healing very nicely, and he got me flexing my foot up and down a bit and seemed happy. I was then fitted with a vacoped boot and he went through the next few weeks in outline:
- Physio starts now, twice a week at first, to a protocol his secretary is emailing me
- I’m weight bearing fully from now, but with the boot still locked/set at quite an angle. Saying that, I’m still using crutches until I find my balance and build my confidence a bit!
- Boot stays on at night, but that may well change after my next 2 week consult
- Moving towards boot off after 8 weeks ish
This is all good stuff and very encouraging…I hope this increased movement will ease some of the cramps I’ve been getting down the muscle on the outside of my shin…and I’ll actually be able to contribute a bit around the house as well. Back to work tomorrow for a week of shorter days as I try to avoid crowded trains, but as the title says, Progress!
June 24th, 2013 at 12:36 pm
Great news. You sound like you are in great spirits and well on your way to recovery. Good luck with PT and work! I’m hoping to start PT at week–so I’m a bit envious.
June 24th, 2013 at 12:49 pm
Wow - I’m impressed. You seem to have a very great dr. who believes in early exercise. I’m chomping at the bit waiting for PT at week 7! Could you post your protocol when you receive it?
June 24th, 2013 at 1:03 pm
Thanks, I try to be optimistic and positive about stuff…but 2 weeks on a sofa does test that a bit. I have been pretty impressed by my doc, I haven’t received the exact protocol yet, but I know it is very similar (or may even be the same) as this one that I googled while I wait. http://www.cfas-uk.com/pdf/vacoped-rehab.pdf
June 24th, 2013 at 2:17 pm
Hi suddsy sounds
like your receiving good care is it NHS
June 24th, 2013 at 2:20 pm
Very good - but BUPA
June 24th, 2013 at 4:07 pm
Suddsy
Royal Devon & Exeter Hospital (NHS) uses the VACO boot with an almost identical protocol and its results (2008 - 2012) are evidenced at http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_18/16.abstract.
246 patients over 3+ years, non-op and surgical. Amazing low rates of re-rupture.
The protocol follows below and all I can say is that it worked for me (and, I guess, over 200 others). I had physiotherapy from week 3 and after week 16 beefed this up by visiting a top sports physio.
Week 0 – 2 Full equinous i.e. 1st period of 2 weeks In plaster, toes pointed down. Mobilising NON-weight bearing, using crutches or frame. May use toes to balance.
Week 2 – 4 review into Vaco Achilles boot set static at 30º PF
i.e. 2nd period of 2 weeks. Into boot at 30º PF i.e. toes still pointed.
Able to weight bear, can wean off walking aid as comfortable, probably use outside. Wear boot at night. Can remove for very gentle ACTIVE exercises.
Week 4 – 6 review. Boot ROM 30º – 15º PF.
Can remove at night. Mobility improving. Increase number of sessions of exercises.
Week 6 – 8 review. ROM 30º PF – 0º neutral. Boot adjusted by physio. Theraband exercises (some start earlier, I did at week 4, and static bike). Show patient how to adjust at week 8.
Week 8 ROM -30º to +10º.
Adjust boot to ‘step-through’ walking. May start gentle swimming if safe to get in and out of pool without using rung ladders. No pushing off from sides.
Week 9,. Shoes ok indoors with heel pads.
Week 10 review. Out of boot indoors and out. Use heel pads as comfortable 4 – 6 weeks. Can take boot outside too as a precaution if desired or ‘hazardous’. Should be able to drive within couple of days of being in shoes – IF YOU CAN DO AN EMERGENCY STOP!
Increase exercise tolerance with gentle and frequent walks, cycle, swim.
Arrange for additional physio work in coming weeks if required.
If reviewing between weeks 10 – 16 Start to increase exercise tolerance, concentrating on non-impact, non-explosive activities, such as swimming, walking, static bike or bike on the flat (nothing strenuous).
Aerobic gym work as comfortable e.g. x-trainer, treadmill walking, stepper (you may not be able to do some of these).
Not running or jogging for 4 – 5 months post ATR.
OK to make the calf ache, but rest before carrying on. Change activity frequently to avoid fatigue and rest when and if you get tired/ache or ‘burning’ feeling around injury site.
Not advisable to
• Play explosive sports e.g. squash/ badminton
• Do maximum resisted weight work for lower legs, or use rowing machine
• Go up and down rung ladders
• Horse ride (heels go down in stirrups)
• Do loaded passive stretching of calf (heel hangs on step)
FOR 6 MONTHS AFTER INJURY DUE TO THE POTENTIAL RISK OF A RE-RUPTURE!
June 24th, 2013 at 4:49 pm
That’s brilliant info Hillie - thanks for posting. It does look almost identical to the way I’m going, and your and the rest of the Royal Devon’s patients’ experience give a highly reassuring boost to the feeling of confidence I already have in the way I’m being looked after. With a father who was an old-school ‘dr knows best’ GP I’m already firmly in the camp of following the expert’s advice on the particular individual they are treating - fortunately it seems the way my ATR is healing it can be pushed along in this way.
June 25th, 2013 at 2:09 am
Impressive results, Hillie! And the progression to FWB is close to 2 weeks faster than bit.ly/UWOProtocol , with no increase (and apparently a DEcrease) in rerupture rate!
These aren’t huge databases, but it seems from this evidence that jumping right ahead to FWB or “FWB as tolerated” at 2 weeks in — especially 2 weeks post-NON-op — is clearly non-inferior to spending 2 more weeks in a gradual PWB transition.
These results also seem to document (indirectly) brilliant or superior results from FWB long before the attainment of “neutral” position of the ankle — one of the two rehab options that RyanB graphed, and which he and I have discussed on his blog and maybe mine.
June 25th, 2013 at 4:11 pm
Hi hillie, great info thanks, when at 16 weeks you met sports physio what kind of stuff did you do I’m 18 weeks give or take
June 26th, 2013 at 2:46 pm
Suddsy, you did well finding that pdf with the protocol. The wording on mine varies here and there, especially the third column, (PT and me added to this as we went along, depending on progress, aspirations, etc) but is essentially the same regime. Without reading it, it looked exactly the same as the Exeter version - I had to type mine in using Word from a paper copy as I haven’t seen an online version to link to. Looks like Exeter’s team and the London people have either worked together, with Vaco for sure, or?
Apart from the initial incident, I had no pain, no infection (well I wouldn’t would I thanks to non-op), some calf swelling at times (it was a high injury site), and after week 4 for a short time, generally used a crutch only on potentially tricky ground
In us sharing the protocol and Exeter study news, it is also interesting to note that I was non-op (and advised by an ortho surgeon), and you had surgery. I will be very interested to follow your progress.
Today, over a year after my ATR, and taking a few days leave, I’ve been walking the undulating cliffs of north Cornwall with my dogs, taking to a highly pebbled sloping beach, walking on deep clinging sand (tide was going out) and in rock pools. I can think of nothing that I can’t do now that I did before my injury. Personally, and recognising that we are not all the same, I can only be grateful that I had a great protocol to follow and worked with excellent NHS medical staff.
Accelerated protocol, early mobilisation, non-op if you can – the way to go…
June 26th, 2013 at 3:02 pm
Rip, the sports physio stuff was mostly routines familiar to many exercising types. The hard part for me was the way the intensity increased over a 10 week period - the guy certainly didn’t take prisoners but on the other hand he only really pushed too hard on one occasion.
At random, and I apologise for the cut and paste from my old crib notes, the routines included:
Heel Raises – progress (For those of you fretting about not achieving this, be patient (mine took 18 weeks from ATR) and ask your physio to show you ECCENTRIC raises to help your calf muscles to remember how to work.
Calf stretches inc both knees bent
As much walking as was comfortable (+ some!)
Squats/Lunges – alignment/stability/half depth and single off step Static squats against wall with heel raises 2×10reps, increasing
Rower
Leg press, knee extensor
Treadmill
Static bike
X-Trainer
Pool running, walking, swimming
Stepper
Power-Plate
And contrast bathing for my leg to alleviate calf and ankle swelling. Now this did hurt for a few seconds but worked so well.
I haven’t included numbers of reps etc but I’m sure that you can add to this ok.
Hope this helps, good luck with the recovery.
June 26th, 2013 at 4:52 pm
Great help thanks hillie
RRR
June 26th, 2013 at 5:04 pm
Hillie, great to hear where you are now…and while it seems a fair way from me at 16 days post-op, perhaps one of the benefits of pushing along with an accelerated protocol is that feeling of progress. Today for example I spent the morning on 1 crutch, took a 400m walk with it and only then reverted to 2 as I felt a little tired and wobbly.
Interestingly, though my doc said fine to FWB from now on, my confidence is not yet up to it. I’ll stand unsupported, but the full motion of walking seems to be pushing it beyond what feel ‘right’…another try tomorrow!
It will be fascinating to compare notes op vs non- op. I have very little swelling or pain, and while my heel is a little numb and tingly it’s no big deal. I do get strange sensations around and below the incision site on the tendon, almost like something large is trying to crawl up it…but this is presumably it healing….
My only issue is with the cramps I’ve been getting at night - the side of my shin with splint on was painful, but has now gone away with the vacoped, to be replaced by a slowly building cramp across the top of my foot that wakes me up every couple of hours and needs to be pressed to be released. I think I’ll try to sum all this up with pics post my first PT session on Friday, if I can figure out how to add photos.
June 26th, 2013 at 6:12 pm
I am 12 days post op. I see my surgeon Tomorrow and I cant wait to get these stitches out. It seems to be healing very well. I had accident today where I was on my stroller and I hit a hole and fell on my injured leg, thank god for the boot but all my weight fell on it and I didnt feel anything but it scared me to say lets go in the house and ice just in case, seems just fine no pain. Close call.
June 27th, 2013 at 11:11 am
Interested to read Hilli’s protocols from Exeter, at the end there is a list of DO NOT’s which include Not advisable to
• Do loaded passive stretching of calf (heel hangs on step)
FOR 6 MONTHS AFTER INJURY DUE TO THE POTENTIAL RISK OF A RE-RUPTURE!
I’m a bit unclear re definitions on some of these exercises, I’m currently instructed to do eccentric exercises which involve standing on a step, lifting heels up with weight on good leg, transfering weight over bad leg, then lowering heels to below step level whilst simultaneously transfering weight over to good leg side.
If any one can understand my gobbledy gook description do you think that they are the same as a “heel hang”, or is a heel hang where you leave your heel over the step for say 30secs at a time?? I’m seeing my physio on Monday so can ask then, but was concerned when I read the DO NOT bit….
June 27th, 2013 at 2:56 pm
Hi Micah
Your words “DO NOTS” is not the same as the protocol’s “not advisable”. As far as ‘heel hangs’ was concerned the physio’s used their initiative, and the fast-improved condition of my AT repair, to justify beginning this, probably at around 17-18 weeks. And I wasn’t forced to do anything too ambitious.
That was while I was with the sports physio but even before that, when working with the Exeter guys there were opportunities to bring activities forward e.g. theraband and static cycling.
For new ATR victims, mine was a non-surgical repair to a full rupture - and I had already lost 10 days due to initial GP diagnosis of a damaged calf muscle.
June 27th, 2013 at 11:37 pm
Suddsy….I didn’t realize your two weeks behind me. Did you wait two weeks to be treated? I couldn’t tell by reading your stats. That would make us almost twins.
I’m actually rather jealous of your treatment protocol minus the surgery. I may live vicariously through you while I’m in home incarceration, I mean healing.
Hillie…. You are no joke. I am inspired reading your accomplishments. Thanks for posting this, i get casted tomorrow and I will see if the doctor is receptive. I am a full rupture going the non-op route.
jodahl - glad you weren’t hurt. happy healing.
September 19th, 2013 at 1:28 pm
Ron and co
This post of Suddsy’s has been referred to many times and has contributions from a number of those who post regularly. Worth a look.
September 23rd, 2013 at 5:05 pm
I am still scared to go this aggressively with my recovery. My stitches are not 2-3 inches, they are double that and my gap was 9. This has to depend on how severe the injury was, right? I am struggling with trying to go PWB, let alone NWB. LOL.
Thanks,
Ron
March 21st, 2016 at 3:21 am
Hey, very nice site. I came across this on Google, and I am stoked that I did. I will definitely be coming back here more often. Wish I could add to the conversation and bring a bit more to the table, but am just taking in as much info as I can at the moment. Thanks for sharing.
PF Night Splint
Keep Posting:)