Ugg (boot)
It’ll be 8 weeks tomorrow. My surgeon said at 8 weeks I could stick a couple of heel pads in a boot or high-top sneaker. My physical therapist seems dubious. I decided to give my Ugg boots a try since a) living in Texas I rarely have an opportunity to wear fleece-lined boots and b) everyone hates them so, now, I actually have an excuse to wear them.
I’m feeling a little naughty and reckless. My doctor said it was ok but she hasn’t felt my tendon since she stitched it all back together. My physical therapist spends an hour with it 3 times a week. But he’s also a very cautious.
I’m trying to follow Norm’s UOW protocol http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ as best I can with all the mixed signals I’m getting and my family wanting me to be as conservative as possible. In the protocol it goes up to 12 weeks but I don’t see where shows enter the picture. Also, I don’t know where bare-feet fall in.
Now I just have to figure out how to get the darn boot off without taking the achilles with it. In hindsight a zipper boot or lace up would have been preferable
Hi Lisa, I love my uggs, as unfashionable as they are which they are here in Australia too…..they sure are comfy! But I haven’t tried them on, have thought about it though.
Be careful, I’m only at walking bare feet, 3x a day about 20 steps, less weight on the crutches each day. Haven’t even tried a shoe on yet. It’s the silly season so my PT wanted me in the boot while out n about. The goal as he tells it, is to ween me off the boot, and then we start doing some “work”.
Happy healing xx
Comment by mandy000 — December 30, 2012 @ 6:42 pm
1) The UWO Protocol — together at bit.ly/UWOProtocol — says “wean off boot” at 8 weeks post-whatever. Many of us kept the boot handy for scarier outings for another week or two, before consigning it to the attic.
2) Your nervousness about taking the boot off — and putting it on, too, since we usually strongly flex our calf muscles while getting INto boots! — is one I share. During my rehab, I took a while to start wearing a high sock inside my boot, and hesitated to wear compression socks, because the off and on made me nervous.
3) If going slower led to better outcomes and a lower risk of re-rupture, then it would be “conservative” as opposed to “daring” or “gutsy” — the way investing in government-guaranteed bonds is more conservative than lending all your money to your brother-in-law for his new business.
But the evidence shows that it doesn’t. Studies that use the fastest protocols generally have the best results, including the UWO study using that protocol linked above. Post-op, going slower doesn’t seem to do a lot of harm, but it doesn’t help either, according to the studies I’ve seen (several of them linked from this website). Non-op, going slower is clearly worse, with significantly HIGHER re-rupture risks. What’s “conservative” about doing something that RAISES your risks?
Comment by normofthenorth — December 31, 2012 @ 3:54 am
BTW, if you’ve fallen behind that UWO protocol’s schedule, then I’d be gradual about catching up, rather than just jumping ahead. E.g., they started PWB at 2 weeks and FWB (as tolerated) at 4 weeks, then they wean off the boot at 8 weeks. If you did PWB and FWB later than 2 weeks and 4 weeks, I wouldn’t insist on catching up all the way and starting the “wean off boot” at 8 weeks. The intervals matter, as do the exercises and PT that you do during those intervals.
If you’ve fallen behind, you can progress a bit faster than UWO, but I wouldn’t just skip a week or two.
Comment by normofthenorth — December 31, 2012 @ 3:58 am
Thanks Norm. I was actually wondering about the importance of the intervals. I never really had a PWB period. I’m curious about how/when to throttle back or what the deciding factor in going to the next step is when one has almost no pain and pretty good ROM.
Comment by Lisa — December 31, 2012 @ 4:51 am
I found this which seems similar to the UWO protocol in a nice chart. http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-27399_AchillesTendonProtocol.pdf
Comment by Lisa — December 31, 2012 @ 4:56 am
Lisa, that presentation is lovely, but I’m not confident that the content is sound or evidence-based. All their eferences are to other people’s studies with varied results (& NOT updated to include UWO 2010!), none of which used the rehab they propose! So I’d stick with UWO because it’s fast and its excellent results are evidence-based — i.e. you can check the results from THAT protocol. Your AT won’t heal any better because somebody put a reasonable-sounding best-guess protocol into a nice chart.
Some parts of their protocol seem nuts. Waiting ’til 8 weeks to get on an exercise bike is one, offhand. There are other significant differences from UWO. It’s hard to tell HOW significant without evidence. Maybe the diffs don’t matter, maybe the Wisconsin version works better… Nobody knows, or can tell. My approach is to stick with the path that produced the best average results in a large careful study, and let others experiment. Your approach is your own, and your Doc’s and PT’s.
Comment by normofthenorth — December 31, 2012 @ 2:53 pm
It would add to the debate about achilles tendon rupture rehab and protocols if University of Wisconsin Sports Medicine were to respond to these posts. It must also be likely that some its atr patients are readers of achillesblog, and they might want to respond - please do…
Similarly, we do not see posts from the professionals, unless they’ve had an atr themselves. Is it not the done thing in blog etiquette for the professionals to respond too? So long as they are not using the blog as an opportunity to promote their organisations, I don’t see anything wrong and they could give us all some useful insights. In other sectors, techies do respond - some say who they work for and sometimes they also add “these are my views and not necessarily those of xyz corp, etc”.
Norm, you might be right in what you say. To quote you “Nobody knows, or can tell”. Much of the content presentation makes total sense and is similar to other protocols, but other parts, such as the exercise bike at 8 weeks are off track (IMHO). The frequency of follow-up visits is high too, and somebody is paying dearly for that. I’d stress that I’m being totally impartial here (devil’s advocate if you like) but I’m not aware how any of us would call it a best guess protocol in a nice chart. They may be massively experienced (I have no idea) but not published lots of papers. Yes, their response would be good here, help to clear the muddy waters.
Comment by hillie — January 5, 2013 @ 12:21 pm
I’m with you, Hillie, I wish a great blog like this could be a forum for informed contact between patients, professionals, and even non-professionals like us who are trying to read the literature and figure out what is known and what isn’t. In the early days of a_b_.com, I think one of the frequent posters was a health professional, but he had virtually vanished by the time I showed up toward the end of 2009(!). When I was new, a frequent and very well-informed poster was doug53. He was/is actually a prominent doctor, but his practice/specialty had nothing to do with ATRs, so he posted as an informed non-professional.
My other online medical-blog “addiction” — http://www.valvereplacement.org — has had a FEW more professional posts, but still very few and very far between. There’s still a big perceived gulf betwen what goes on at professional conferences and in referreed journals, on the one hand, and what goes on in “citizen science” on the Internet. In a few fields — astronomy is one, and Climate Science is arguably another — there are little streams of fruitful contact between the two solitudes, but that’s still the exception rather than the rule.
Recently, I heard (on CBC Radio “Spark”, IIRC) that a group of professional astronomers with an unmanageably large database of recent telescope photos, enlisted the help of amateur astronomers to help classify the galaxies in the photos. They set up an online forum so the volunteers could help each other out and share skills, etc. After a few months of this effort, the volunteers/amateurs went back to the professionals with what they were convinced was an unrecognized “new” class of galaxies — and that’s exactly what they had discovered!
Heck, when I was teaching professionally in prestigious universities, a faculty member could be reprimanded or even denied tenure on the basis of “uncollegiality” for spending too much time with grad students instead of fellow faculty! These “classes” do exist, and are often informally enforced, and often to the detriment of an objective pursuit of the truth.
And Hillie, I think that most health professionals proceed LOTS of the time on the basis of best guesses and rules of thumb, just like all the rest of us professionals, and the rest of us humans. That’s why Evidence-Based Medicine is still such a controversial topic in so many quarters, and why we are still discovering popular treatments that turn out to be less effective than placebos, when they’re finally put to the test. I don’t mean to demean U. of Wisconsin, but I think even the UWO-study authors, after doing the biggest and arguably most careful study of ATR treatments, softened their rhetoric a bit between 2009 and when they actually put out their data in a peer-reviewed journal, in 2010. Until it’s published and subjected to outside scrutinu, it’s easy for humans (from U. of Wisconsin or anywhere else) to overstate their confidence in their beliefs, even to themselves.
And it IS a nice chart, but that doesn’t make the contents any more true or evidence-based or worthy of repeating, does it? Even if they’ve used their own protocol 1000s of times, unless they’ve systematically compared their results to the results of other protocols — preferably with patients randomized into the two — any thought that it’s a good or near-optimal protocol remains a “best guess”, at least the way I was raised to do science.
Comment by normofthenorth — January 6, 2013 @ 3:37 am