travelmark’s AchillesBlog

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There’s limping and there’s limping! Most of us took a long time - AKA “the frustrating plateau” - before we lost the “dip” at the end of a long stride, either from lack of ROM or (more often) lack of calf strength. Initially in 2 shoes, the asymmetry is huge: you can stick your weak foot as far forward as normal, but you can’t stick your “good” foot in front of the injured foot! People who’ve had hinged boots have an edge, but we all have similar problems when first going to 2 shoes. The trick is similar to when going PWB & FWB: make your stride as normal as possible.

There’s nothing wrong with having an asymmetrical stride, one side longer, one shorter. Or dipping a bit at the end of one of them. Just keep walking - and resting, elevating, icing, and maybe compressing - and apply “tincture of time” and it will gradually improve. Do NOT adopt any other funny walks! No toes out to the side, no peg leg walking, etc. Even small accommodations to inflexibility or weakness or discomfort can create lingering gait abnormalities that are tough to lose later, and/or cause physical problems with knees or hips or backs etc.

Thanks Vicki, I am planning to take the boot but seeing as I have waited what seems like forever to be back in shoes I think I would have resisted wearing it as it would seem like taking a backward step, You have been there and done it, so I will take your advice. I have practiced walking on the carpet and cannot stop the limp, how long were you limping for ?

^^^that was for brisy, lol^^^

My advice would be to take your boot with you. Whenever you are fatigued or out amongst a lot of people, it will make you feel much safer. You can gradually work your way into 2 shoes. I know I felt so awkward the first time in real shoes again. Don’t feel like a wimp if you have to go back and forth between the boot and shoe. After a week or so, you’ll get more comfortable.

Have a fun and safe trip!

Vicki

I am feeling very nervous also as I too am approaching two shoes day May 2nd, it will be 12 weeks post surgery when I finally start walking my consultant has been very cautious and told me re-ruptures tend to happen at around weeks 10 to 11.
When I remove the boot and flex my toes upwards the tendon feels tight. The day after I go into two shoes I have a weekend away with friends and I am concerned about how much walking I will be able to do. Any advice would be appreciated.

Slipping and overdoing have also caused reruptures, so watch your step and stay incremental.

A major milestone, well done! I bet you felt great getting back behind that wheel.

Congrats!

ha! i get the ski injury question all the time here that is funny. I just started telling people I was training for the Olympics when I tore my achilles.

Watch Your Step and follow a good path, so you can tell them an encouraging story AND tell the truth!

This is the first that I have heard about the Vacocast so, I had to look it up. I WANT ONE! OMG how much easier so many things would be. Of course I can’t afford it and insurance won’t cover a second boot (I already tried) so, I’ll just dream about having one. lol

I am so sorry about your fall. I could see how that would have gotten complicated. I hope someone offered to help you after it happened, they should have offered you help before!

Mark, you are behind bit.ly/UWOProtocol and Exeter and all the other successful non-op protocols, which get to FWBAT (as tolerated) at 4 weeks. What’s holding you back? Don’t jump way ahead, but do catch up if you can.

Reliable non-op success seems to be tightly linked to following a good modern protocol, and going significantly slower increases risks, according to the evidence. That part is science.

I wasn’t truly fwb and in shoes till week 8. (Though I was bearing weight on the vacocast). Now at about week 13, I have some minor pains that are dissipating, but am at what my OS told me was close to best case scenario for recovery.

I bought the even up. I was underwhelmed. When I wore the rocker sole the even up didn’t quite even me up. I also didn’t think it had enough traction. A good shoe with a thick sole could probably do it also.

Take Care. Enjoy the boot!

TravelMark,

Congrats on the Vacocast. I loved that thing. I was told that I could start sleeping without it at 4 weeks, as well as take it off when I sat down to watch TV. My biggest fear while sleeping was kicking the wall or the bed post or, getting up at 2 am without thinking and just walking to the bathroom. I like the restricted water intake idea. LOL.

Brain
Check out Norm’s modern protocols, they give you a good idea when to start PWB, FWB, 2 Shoes, etc. But I started PWB at 6 weeks, FWB at 8 and 2 shoes by 10 (ish).

Seeing I had been wearing a splint for the last three weeks and that potentially I could have walked on it during the night with that (very bad) I think I can handle sleeping without the Vacocast on. Nice to be putting a bit of weight back on the injured foot. Should have bought the even ups right away. Do have to say though the Vacocast is comfortable and I feel good about being in it and being able to take it off to clean up and change.

Congrats on the Vacocast. Having that boot made my 5 weeks in the boot enjoyable and allowed me to be really active.

Brian - I was in a splint for 10 days and then was casted. and then had a boot. But I needed to be protected from myself. I can’t believe I’m saying this, but the cast wasn’t so bad. I walked on my cast so I went from NWB to FWB pretty quick. The important thing is to listen to your body. If it hurts, don’t do it.

Good luck and welcome to the club!

I’m just about on your same timeline……I ruptured my Achilles on Jan 29th, had surgery on Feb 4th, and was put into a splint. I go back to the doctor on Feb 14th, to be put into the boot. Is this pretty common as far as timelines go? Anybody have any thoughts on how soon PWB or FWB should start? I was just thrilled to not be casted, as my best friend had the same injury two years ago, and spent a bunch of time in the cast.

I second what Norm said, only go without the boot in bed if you are sure you will be functional enough in the middle of the night to put it on, if you need to make a bathroom trip or something.

I was grateful at 3 weeks out to be able to ditch the vacocast for sleeping, but I really restricted my fluid intake the latter part of the day so I wouldn’t want to get out of bed at night. Crutches in the dark are no fun, either!

Congrats on the PWB!

The AirCast doesn’t claim to be waterproof, but I’m not sure it isn’t. I washed out the foam&Velcro liner on mine then wrung it out between chamois cloths and put it back on. It seemed fine. The shell is all plastic and should be fine…

Well good luck with the boot and congrats on being able to go swimming and get around. I just finished week 3. I have a boot, but the aircast. I sure wish I had your boot since it is waterproof! I guess you get to wear in the shower too?!
I am still not weight bearing, but I always take my boot off to sleep. It’s hard enough to get comfortable without it, so having that big thing would definitely make it hard I think. Not sure what others do, my dr. said I could go without it at night. I just keep my crutches handy next to me if I have to get up.
Happy healing!

Sleeping is definitely good. But getting up in the middle of the night without a boot can be very bad, so do be very careful.

Getting into the vacocast will feel like a mercedes. I think you will find it much easier to transition.

You will do great!!!!! make sure you tell us how it went.

Finally figured out the time line…a little new to this blogging thing! Two more days till my Vacocast shoes up. I will look at some of the leads you have given in this blog thread as I get ready for some pwb. Getting very tired of the crutches, slow sore and hoping around on one foot is getting old quick.

If you can install the ATR Timeline Widget (instructions on the Main page), we’ll all be able to check your FAQs and timing.

8 weeks in a boot is pretty standard in the good modern non-op protocols, BUT with pwb starting around 2 weeks in, and FWB by about 4 — e.g., a la bit.ly/UWOProtocol . 6-7 weeks before FWB is 2-4 weeks too slow for lowest-risk non-op treatment.

Some protocols move gradually from equinus to neutral, others stay toes-down for 6 weeks then flat. . .

The good news is that folks here LOVE their VacoCasts! And with it you can follow the successful Exeter protocol — with gradual introduction of ROM-hinging in your fancy boot. Look for it on suddsy’s blog and several others, from hillie. She’s very happy with her progress following Exeter non-op with a Vaco.

Lots of OSs still prescribe slower rehab, on the outmoded superstition that slower is safer. (MUST be safer, because it’s called “conservative”!) The evidence shows that it’s actually riskier, and faster is safer, unless you go faster than UWO or Exeter. And since going slower is a real PITA, it’s a no-brainer.

That’s what I thought mine was as well - at least initially.

Hope things work out.

Ron

Good news. Good luck!

12 weeks in a boot is much slower than the most successful published protocols (like the UWO-study protocol I linked above).

Sara Ann did OK, but the studies and meta-studies show unacceptable rerupture rates, 15% or higher. (That still means 85% escape, but Don’t Go There.)

Brady Browne, IIRC. Maybe Brown.

I was op myself and am fine with that. However, if you want to get some inspiration for non-op recovery, there is a youtube video of a CFL player floating around which is really amazing.

Possible search words on this site for CFL youtube or on youtube for CFL achilles.

Hi Mark,

I had a full rupture in July. I struggled with the decision of surgical or non-surgical. I went non-surgical. it was a long road. I was in a boot for 12 weeks. I rented a left foot accelerator, as it was my right foot, which was a huge help! Now six plus months later, I feel that I am in pretty good shape. I am riding my bike, doing a little bit of Irish step dancing and working out at the gym. My OS and PT are thrilled with how it looks. I do occasionally have some pain and tightness, but it is a good reminder to me to go slow and keep stretching and strengthening my calf muscle. I am happy with my decision so far.

Good luck!

OOps, I meant to say that it definately gets better week by week. Its really useful to keep a blog, not just to share and inspire others, but also so that you can check your own progress. There were weeks where I seemed to plateau for ages and feel that I had made little progress, but then when you read back at where you were in your recovery 2 weeks prior………etc. Progress can be subtle!

Hi TravelMark, I was also non-op. You can read my blog on here but I essentially had a rapid rehab with nearly 3 weeks in a cast, then 4 weeks in the boot (removing a heel wedge each week), then straight to 2 shoes. Its felt like a slow recovery despite being described as rapid. The worst time was the early weeks when I could neither drive or walk up our hill to freedom! best wishes with your recovery. Micah1

I don’t know how your calf injury changes things, but going slower than bit.ly/UWOProtocol generally INcreases the risk of AT reruptures, so.I wouldn’t go (much) slower.

TM, you can check my page “The case for skipping ATR surgery”.for a review of the evidence. Interestingly, there’s NO evidence (AFAIK) about the effectiveness of modern fast non-op treatment of PARTIAL ATRs — only COMPLETE ruptures (where it’s surprisingly effective). Logic suggests that it should work OK, but logic is often wrong in this field!

Good luck, and keep us posted. (I’m just back in TO from a week out your way, skiing in Whistler.)

Hi Mark,

I too had a partial rupture (60%) which my doctor initially misdiagnosed as a calf tear. I was pretty sure I had torn the achilles, but the doctor wouldn’t believe me until I went back a week later and there was alot of bruising and blood settled around my ankle and foot. An MRI finally confirmed it.

My ortho did not suggest surgery. I was in a boot, non-weight bearing and started PT at 7weeks. I honestly don’t remember when I got out of the boot. This was in 2012 and I didn’t keep any notes. At about 5 months I had another MRI and it showed that the partial rupture was at 30%. I was definitely in two shoes at this point. I’d say that the tear was healed well enough by 9 months. I was working out at the gym and able to walk well. Running was another issue which was the heel bone rubbing against my achilles. This is what eventually sent me into surgery (with a different ortho). Another MRI at 1 year confirmed that the rupture was fully healed.

I think non-op, at least for a partial rupture, is the way to go. It definitely healed well for me. My PT was also amazing. She was very aggressive and I was religious with my

Mark, Sorry to hear you’ve been taken by the tendon troll. That pain in the upper calf is what I felt with the first one 4.5 years ago. The right one was a bit more “controlled”. A definite tear but not as traumatic in my opinion. A few strands left as I understand. Non-op is going extremely well on this one. I am six weeks out from the injury. I was in a boot right away and healing is going very well. It is amazing how the gap has filled in and the tendon has tightened right up. I think it likes being just a tad longer as it was probably too short to begin with. Anyway, good luck with your recovery and be patient.
Chuck

Hi Mark, I hope you’re able to find useful information about non-op treatment and recovery on this site. There seem to be a lot of people who post here who have had great experiences with that approach.

I did have surgery (and a rerupture and second surgery which I am currently recovering from) so can’t advise too much on non-op treatment but I certainly sympathise with the extended time on crutches! If you have family and friends around and they are offering to help, definitely take them up on those offers. I have been getting out and about with taxis as well - I figure I am definitely spending less on socialising overall so its okay to throw a little money at the transport problem! Not sure if that is possible for you but it definitely helps to have a change of scene even if it just to meet someone for a coffee or something.

Good luck with your recovery - do you know when you will be able to start to weight bear and say goodbye to the crutches? That will make such a difference and make things altogether more bearable!