Currently at 5 weeks and 1 day since my surgery. Overall, I am feeling much better and much of it has to to with PWB.
A quick run-down; I was in a splint/soft cast for 3 Weeks post-op. Then, stitches out, into a VACOcast and further NWB for 2 more weeks. That meant 5 weeks total post-op NWB.
VACOcast: Initially, I found the VACOcast to be a b*itch. I was rather unhappy with the fit at 20º, the second strap was just putting too much pressure on the top of my foot, which is a little bony in that area. So a portion of the top of my foot was pretty severely inflamed, I tried putting some cut up fleece on top and under the plastic of the boot, but the damage was mostly done! After some long work and travel days, I started to get pain and moved the boot to 25º, which not only helped the fatigue and Achilles pain but also position the boot in a different manner so the top of my foot got a relief.
First Physical Therapy Session: At 5 Weeks I had my first PT appointment and it went ok. Apparently, I hadn’t kept my leg straight often enough during my 5 weeks post-op and now I can’t stretch my leg straight out entirely to where the back of my knee can touch the floor. It’s an odd feeling and perhaps should have been obvious during my recovery. But I did have some decent pain the first couple of weeks and all I could focus on was simply getting comfortable. That meant having my splint elevated and my leg slightly bent to take pressure off my legs, knee and calf. No one told me to keep it straightened out and work in some light quad/hamstring stretches during this period. Maybe shame on me? !
So the PT was concerned that I was going to have a pretty decent haul for recovery given that my Achilles ROM and flexibility was rather low too. I should note that I waited 18 days post-injury to get surgery, so I will have been nearly 8 weeks NWB. I will admit, the PT session was a bit scary given my 8 weeks time and I was apprehensive to push my Achilles too much, particularly in the straight-back stretch! At home, I’ve able to concentrate much better on these exercises and now am able to see some teeny, tiny improvements in just 2-3 days. My Physical Therapist recommended that I have 2, if not 3, PT sessions per week as they deemed I might be a little behind the curve in recovery.
PWB Finally!: Going PWB (as tolerated) with crutches was the saving grace at the PT appointment. Wow, what a difference. I’m actually slower now that I was at NWB on crutches, but that’s ok. I love being able to finally feel my body/ankle/Achilles, let it respond and go accordingly. When I put just a bit too much weight on it, there’s definitely a deadness/dullness sensory along a major tingle in my heel I think telling me to reel it in a bit. I’ve started walking about 30 minutes each day in addition to my ROM exercises 3x per day.
The "Small Achilles": Lastly, I was very frustrated at 3 weeks and being told still NWB for 2 additional weeks. I realize many (most?) on here start PT and PWB at 3-4 weeks. I was wanting to follow the University of Wisconsin protocol as it was recommended to me by a family member who is 10 months ATR. I sent the protocol to my Dr, PA and future PT at the time and voiced my frustrations. They came back and basically said that they do indeed like to start PT and PWB in most of their patients at 3 Weeks, but not me.
Given the severity of my injury, the fact that I walked on it for 5 days post-rupture, waited 18 for surgery, my age, desire to return to action sports, physiological makeup, they wanted to wait with me. They also stated that I have smaller than average Achilles and that was a major factor. I found this interesting and was a bit skeptical as all I wanted to do was start PT and PWB! But they said the size and diameter of both of my Achilles is smaller than the typical male’s and one for my size (6ft, 200 lbs), thus keeping a more conservative protocol. I have always noticed (or thought) I had pretty skinny Achilles along with skinny legs, ankles. So I did understand, to a degree. They said it was entirely genetics, wasn’t actually too uncommon and that it still didn’t contribute to it tearing. There’s also no real concern that there’s that much more of a propensity to tear again (or in my good one either).
My Ideal Timeline: According to my PT, they want me to be 0º in one month from the start of PT/PWB/Week 5. That means lower my degree of VACOcast 5º per week. 20-15-10-5 in 4 weeks. I think this sounds positive and then, if all goes well, I could get into shoes with a heel lift. But all of this is going to take solid PT and home-exercise work on my end.
But everyone is correct, going to PT and PWB is a huge confidence boost and while I had to wait 5 weeks post-op (8 weeks total), I can halfway imagine walking normally again!