4 and a half weeks! Second post
It’s been 4 and half weeks (31 days) now since the operation. Since my last post I decided to take it a bit easy with the weight bearing to prevent damage, as I feel a slower healing process with no injuries will be significantly better than a rushed approach where I reinjure myself. However I am seeing clear progress with the weight bearing at a natural rate. Over the last few days I am finding I can put considerable weight on the repaired foot, if I try hard I can walk with one crutch but do not feel confident yet in order to do this. So I am positive with the progress I am seeing. Hopefully by my next appointment I can be walking with one crutch, hopefully none! However as my foot is not at 90 degrees in the cast, I find it difficult to put weight on the foot in a natural position. When I put weight on the foot, it pushes the leg into a locked out position.
After reading other member’s posts and normofthenorths comment on my last post, I think at my next appointment I will push the doctor for a boot. I assume he will give me one anyway as it seems the next logical step. In response to your comment on my last post norm, the pain I was experiencing was around the calf area where the tendon is attached to. It wasn’t on the surgical site, heel or the rupture area itself. I felt it was more due to tightness more than anything else. But I am no doctor so I could be imagining it for all I know. I have been doing a stretch where from a lying down position, I raise my repaired leg so that it is straight from the ground. This helped minimise and eliminate the pain I was experiencing around the calf. In my opinion I thought it loosened the calf and tendon, however after reading about the possibility of the tendon repairing long I have decided to not do this so much as I am becoming concerned that I may increase the chance of this occurring!!!
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If you raised your whole leg, that shouldn ‘t give your AT much of a stretch. It’s dorsiflexing your ANKLE that does that. Discomfort high in your foreleg, remote from the ATR, is probably nothing serious. Your whole leg has been through a lot…
Pratik
Assuming that you will get a boot at your next appointment could result in disappointment!
It does seem logical but just go pre-armed with plenty of information and questions. If it goes badly e.g. being re-cast, ask if it is really cost effective to do this, rather than having an adjustable, preferably hinged boot. I had the admittedly expensive (supplied by our NHS in the UK) VacoPed Achilles boot but these can be returned to the hospital and refurbished/recycled at minimal cost. Plenty of info on the internet via YouTube and makers’ websites.
Good luck, and don’t accept second best.
ps where in the world are you?
I’m based in Bromley. South east London. Where abouts are you based?
I feel I have read up enough. So I know about the next stages, such as being in a boot. Removing the wedges over a period of time. So I intend to bring this up when i have my next appoinemt. Is there any questions you’d recommend asking to ensure I get the best possible treatment. I’m finding with the NHS if you don’t push them, you won’t get the best treatment.
However I’m not quite sure what to ask to ensure I am pushed along at the normal rate.
Do you have any tips in order to ensure I get the best treatment?
So, does “read up enough” include advice gained from protocols published on achillesblog.com? See home page if not.
Even for surgical cases, most new protocols would have had you in the boot 2 weeks ago, but this does depend on the nature of your injury and the surgery that you suffered.
Boots don’t all have wedges by the way - mine was externally adjustable (no wedges), hinged to give an increasing range of movement from plantar flexion (pf) to dorsiflexion (df), and was still 1 - 2 kg lighter than many of the more traditional designs. Rightly or wrongly, I believe that the ROM gave my calf and tendon, reduced the level of muscle atrophy that many suffer from.
After about 8 weeks you will hopefully be in 2 shoes (depending on injury, blah, blah) and exercising quite a lot - nothing too strenuous or ‘explosive’ (that’s for 16 weeks and over).
Keep up that upper body strength, have a comprehensive, written protocol, and make sure that your physiotherapist is very good, understands the physiology of the ATR injury and can inspire confidence. Mine, in south west England, had specialist ATR clinics but it was a top centre for orthopaedics in any case.
Don’t forget too - just when you feel that your leg is getting much stronger, say at about 10 - 12 weeks, you are very vulnerable and at risk of a re-rupture. Misplaced confidence goes out of the window and you begin to move as if you’d never had the atr in the first place - don’t do it! 16 weeks or more before you become that adventurous. Basic healing is quite quick - strength and sustainability take very much longer.
I have read all the rehabilitation protocols on the achillesblog.com, but I don’t think I’ve quite processed them thoroughly enough.
I think I will properly read through each of them, digest them and make sure I absorb as much information and knowledge possible. Also as you mentioned earlier, there is plenty of information on the boot maker’s websites and YouTube. I will make sure I go through all of these vital sources.
Thanks for mentioning the misplaced confidence bit, I can see it happening to myself and reading your comment has made me aware of it. Your comments have been greatly appreciated. Thanks again.
One challenge is to get a clear writen protocol from your doctors. Often they play it by ear, and disagree with each other. Naive patients imagine that it’s all customized for thie specific leg and specific injury, but that’s almost never true. It’s usually just semi-random, old-fashioned, “the way we do it here”. Internalizing all th various protocols is hard, and you don’t want that, you want the protocol that produces the best results, right? I don’t think anybody’s beaten the UWO study’s results in general, so I recommend bit.ly/UWOProtocol . Take a printout to the clinic, maybe with the full-text of the study (results) too. Get THEIR protocol, compare, and argue! Have THEY compiled their clinical results? Are they half as good as UWO’s?? If thy’re better, they have a responsibility to publish and share. If not, they should respect and follow the leaders… Opinions and experience and professional rank (& career advancement and collegiality, etc.) are important to THEM, but RESULTS are much more important to you, right?
Thanks norm for your post. I think I have realised that in order for me to get the best result and treatment from all of this I will have to push my doctor. Otherwise I can see that I will not obtain the best results and feel this is what has happened to me so far.
I have made a list of vital questions that I intend to take with me to my next appointment after doing a lot of research this evening. These will help me understand what protocol they are using, what is next for me and possibly challenge it if I do not agree with them.
Thanks again for your comments everyone. They really do make a difference to someone recovering and I can not stress how helpful you all have been.
Norm is right that the UWO protocol has shown the best results, but it’s also worth noting that it has some variation to the introduction of new exercises, PWB, FWB, etc. each individual also has variation from their injury, placement, time lapse to treatment, infection, etc… Each of these things will affect our recoveries. For example, my ATR wasn’t treated right away, it was chronic, so I suffered much more atrophy even before I was NWB, because of this my surgeon had me NWB for 6 weeks and I wasn’t FWB until almost 9 weeks, and that was pain tolerate, meaning that was as fast as I could possibly progress. As of now Im still behind some as far as my recovery, but I still make progress every week. My best advice beside studying the different rehab protocols is trust what your body is telling you, because the one week I did t do this I develop some Peroneal tendonitis that set me back 2-3 weeks. Good luck and happy healing.
Kevin, where did you find that “variation” in the UWO study and protocol? I’ve never noticed much. Yes, the move to FWB at 4 weeks is “as tolerated”, and at 8 weeks they’ve got “wean off boot” rather than “burn boot”… but with those explicit exceptions and maybe a few others, it strikes me as a quite “1 size fits all” approach to ATR care. I myself added transitions to 2 sudden moves in the protocol: (1) At 6 weeks I “weaned off” the heel wedges over a few days, not “cold turkey”, and (2) starting at ~7 weeks, I “weaned” into a HINGED boot, on my way to 2 shoes. I’m not sure that either variation would have been encouraged or even tolerated among UWO Study participants — the ones with the excellent and well-documented clinical results. But they made sense to me, so I went for them, without any supporting evidence.
I meant the variation can be up to 2 week differences as you make the changes “pain tolerated” I guess I see this as variation. After my NWB days, I had to move slower, because of the pain, and saw this as variation, only because I easily added on 4-5 extra weeks moving slower due to this. This was probably due.to my chronic injury and long stint of NWB.
Hi Pratik, sounds like your doing the right thing in reading up and going in armed with your questions. Hopefully you will get an NHS consultant who is on-board with accelerated rehabs and is able to respond to your research sensibly.
However, be prepared that you will not get the NHS Clinic on board with accelerated rehab if it believes in the traditional slow rehab school. Then you will have to decide to what extent you are happy “going solo” on your protocol.
That’s what I had to do when dealing with an NHS clinic in Hampshire where slower rehab is used. I was told by one Consultant that he would only trust his own experience and not any research. It is not an easy decision to ignore your clinicians advice, so good luck with the next appointment.