The Family came back tanned and healthy looking despite what was described as a wet and windy fortnight in Normandy. Probably just as well I didn’t make the trip as work has been frantic and really filled the two weeks of self sufficiency. With my chauffeur back I was ferried over to a new business meeting half an hour away where the injury made for an interesting ice breaker and the hosts kindly made allowances with a groundfloor meeting room.
I went down to the cricket club to watch my eldest son play a match. I got roped into scoring but couldn’t get comfortable on the bench and there was no room for a prop chair in the scorebox. Perhaps mercifully the game was abandoned at the tea interval due to monsoon conditions. The foot was down for the longest spell in 6 weeks, and the leg swelled noticeably pressing against the normally flappy welly top of the plaster. Purple toes returned with a vengeance, but alleviated when stuck back in the air.
After a week back, the intrepid campers were off again, this time for the wonderful
Green Man Festival in the Brecon Beacons. This was tough as it has been my highlight of previous years, and I bought tickets back in February. I had been in touch with the organisers who said that I could get a pitch in the disabled camping area with proof of disability from the Doctor. However we couldn’t have our 8 man tent and couldn’t be with our friends. With this in mind and a large dollop of weather forecast induced common sense I Ebay’d my ticket at the 11th hour on Ebay. The last two days of the festival were solid rain and the entire site, including much of the main marquee, was turned into a quagmire. How those who my wife saw crutching around on Friday got around I can only guess… they may well have been trapped in their tents. One visitor is after some compensation as he has only one leg and had done himself a mischief trawling around the site after being assured by organisers that the site was accessible. Very poor. A great festival, but seems to have let itself down. Content that I made the right decision to stay at home, I tucked into my Ocado supplied Pieminister “Chicken of Tarragon”pie…the culinary delight first sampled at Green Man 2006.
On the eve of my 8 week anniversary, I made my third visit to the fracture clinic. Plaster off, bliss, and then wet-wiped a moulting Labrador’s worth of leg hair off and awaited the experts. Fourth different consultant arrived and was very enthusiastic about the results he has seen with conservative treatment. Seemed to be happy with what he saw and squeezed, and introduced The Boot. He recommended that I always wear it when upright and can try walking on it without crutches once I feel more confident. When resting , boot off and elevate, no icing (no pint at this stage), and the D&P flexing. Here’s the nurse, see you in three weeks.
Now one thing the NHS have certainly got the knack of is their accessory co-ordination, with every shade of grey applied to crutch and boot, whether metal, plastic or fabric. My poor quip “Have you got in blue in a size 10 lace up” was ignored with the brusque efficiency of the overstressed and underpaid.
Feels really good to sleep without a cast and see the lower limb again, though the shrunken proportions are not enhanced by the huge lovebite on top of the foot the equates to the gap between the neoprene flaps of the boot.
I think for my last 3 weeks in plaster I was not quite at 90 degrees, so wearing the boot has been uncomfortable on the tendon, as it stretches out the last few degrees to meet the insole. This discomfort means I am reluctant to try walking on the boot. Hopefully that will ease in a few days and I will get more confident.
My PT “application” is in at a more local clinic. My wife had to wait three months for her post knee-op PT. Hopefully I won’t have that long a wait!
25 responses so far ↓
Richard // Aug 24th 2008 at 10:48 am
Nice one, did you feel your tendon ‘working’ ie moving your foot when you were out of your cast and did you have to do any exercises to test it whilst at the hospital? - I’m at the hosp on 1st sept for a new cast and a foot move - how long were you in your pre boot cast?. I’m beginning to worry about work(teacher) and not being there at the start of term but I know deep down I’ve got to look after myself first. Good luck with your boot and don’t get too over confident!!
ginger982 // Aug 24th 2008 at 4:09 pm
I got my boot last week after the previous cast not making it to quite 90 degrees. All the hospital asked me to do was pull up my toes as far as possible. Was very apprehensive leaving the fracture clinic (had already been weight bearing with cast at 80 degrees covered by sexy blue NHS velcro shoe although a bit uncomfortable on toes at this angle, but had got rid of crutches all the same and was getting quite quick!), felt a bit freer in boot and tendon felt tight so was worried about putting weight on it so went back out wirh 2 crutches. Was back down to one by the following day and 3 days later was walking pretty well in boot with no crutches. Tendon still feels pretty tight in the morning after leg has been free all night and then back into boot at 90 degrees but less so by the day. Has been nice to get out and about more though and walking further by the day. Don’t want to get too carried away though as know it will be back to snail’s pace once my boot comes off and I have to try and walk with no support (I feel sick just thinking about it!). Am off to States in 3 1/2 weeks for a holiday so really hoping I will be able to at least walk half a mile, however slow! Will be good to hear how you get on with PT, I’m dreading the pain that goes with that!
uknodger // Aug 25th 2008 at 3:12 am
Richard… definitely had a “stronger” ankle flex pre-boot than pre final cast, although there was (and is) still the bambi on ice wobble as the effort goes in. My protocol was: 1 week split plaster cast at ambient hang angle; 2 weeks and then 2 bonus weeks in lightweight cast at same natural angle; 3 weeks at near right angle in cast. All 8 weeks non-weight bearing.
As Ginger982 suggests hopefully it gets easier and universal advice is don’t rush things.
Boot is a mixed blessing…. quite scary to put weight on the leg, plus it is more cumbersome than the lightweight cast. Crutching is easier though,less stressful, and you can stand still(ish)
Good luck in The States Ginger982, whilst that jog up The Empire State may be out I am sure you will have a great time.
richard // Aug 26th 2008 at 1:48 pm
Thanks again for your advice - Are you concerned about sleeping bootless? dreaming of that ashes winning catch at short leg etc etc. I’m a restless sleeper and would definitely be at risk. Also are you able to drive?, imagine no crutches and the car keys - luxury
uknodger // Aug 27th 2008 at 3:31 am
Not had any trouble sleeping without the boot and the foot benefits from being out of cast and boot. I still have some swelling round the ankle (dead blood according to the doc… very scientific) which will breakdown with toe wiggles and foot flexes. I sleep on my back (which I never used to do) with my leg elevated , resting on a soft cushion that nestles on the back of a child’s carseat back rest. Ideal as it is hard foam and slightly rounded which allows a bit of sideways rocking. Foot is raised and supported in a trough if I want it sticking straight up, but can also relax to flop against the sides of the valley. Can also snooze on my side, with a small cushion between my knees with instep of foot laid flat on the cushions. Bliss.
According to the doctor out of cast /in boot the major risk of re-rupture is lifting your weight on your toes or jumping / landing… and the boot is supposed to stop all that happening. That said its curved sole does encourage a step that rocks onto the toes. I don’t think these NHS boots are necessarily best for purpose or equivalent to what our overseas comrades in injury are wearing for ATR. Seems to be designed for bone fractures, but it seems to do the job , though the manufacturers range does include a bespoke achilles cast with heel blocks.(http://www.aircast.com/index.asp/fuseaction/products.detail/cat/2/id/75)
Regarding driving I don’t think it is viable as the boot end is as wide as a scuba divers flipper. Pressing accelerator and brake simultaneously won’t have any benefit!!
jacksprat // Aug 27th 2008 at 12:28 pm
My NHS boot experience has been really good; I was expecting some 2nd hand clodhopper in grey but got a new pretty cool looking boot in navy blue. It says “Medi” on the side “by FGP” and has been excellent. Easily adjustable, I was originally fitted with 3 internal detachable wedges (I was kept in a cast too long) with the boot at 20deg. The wedges really helped because my ankle was locked solid at first. After 3 weeks i have removed all the wedges (1 by 1) and have the boot set to 10deg. I feel lucky; there seems to be a a big difference in treatment from the same organisation (NHS). My boot is not much wider than a shoe and although on my left foot it would still be possible to drive if it were on my right foot, but this will also depend on the car.
uknodger // Aug 27th 2008 at 1:12 pm
Sounds fancy, I wonder if that is more suited to surgical fixes. I had a bit of a snoop on the web and there does seem to be quite a variety of “walking boots”, plus found some tantalising heel supports for sports - though that is several months away! The first consultant who saw me said that I wouldn’t get a boot at all as the NHS didn’t use them.
ginger982 // Aug 29th 2008 at 2:46 pm
I was surprised when I was given a boot a week and a half ago on the NHS but obviously very pleased to half have my leg back !Am scared a bit now thinking of the quality not being as good as others! Mine is a black LanGer boot. Seems to be going ok and am walking pretty well with it. I too worry that I’ll end up hurting my foot in my sleep. Back to hospital on Tuesday and hoping will be told can move to shoes and start physio. Just about at 12 week stage (11 weeks post op). It’s my left foot so thinking may rent an automatic for a few weeks as not sure how long it will take to have enough strength to depress clutch. Any of you have any idea on this one?
Richard // Sep 1st 2008 at 4:52 pm
Poor day today. Went to hosp for proposed foot move and re-cast. Dr not happy with healing and so equinas for three more weeks and muttering about possible surgery if things not improved. I’m feeling like the last seven weeks have been wasted. I must say there was an obvious gap and the squeeze test did not elicit much movement. It has stopped me worrying about going back to work though as I was told in no uncertain terms to keep it still and elevated - bollocks
uknodger // Sep 1st 2008 at 6:16 pm
Richard that is terrible news. I know that the nagging doubt of whether healing is taking place under plaster is bad enough but to find out after 7 weeks is dreadful… and then to have 3 more weeks . I feel for you I really do. Take it easy, you will get there.
Bernardhg // Sep 4th 2008 at 4:06 am
Yes Richard… sad news…. slightly worries me also…… I have been told that the pain of the rupture was terrible for others, it wasnt for me. In fact all I heard was a pop sound, and thought that my shoe broke as I fell over running for the ball. I then could not put pressure on the foot, then decided to go straight to A&E
I am in my 4th week following ATR, and have had only a few pains to speak of. In fact I went to Cyprus for 10 days, 5days after the ATR. Kept mt foor up most of the time. Whilst in Cyprus I had two involuntary spasms in the foot, as if my tendon was in place (has anyone else had this). In the A&E, they did do the Thompson test which showed an inch gap in the left tendon. No MRI scan, just X-ray to be sure that I have not broken my leg also.
So based on others experiences, how do we know if it is healing below the cast?
uknodger // Sep 5th 2008 at 2:21 am
An inch gap sounds a lot doesn’t it. Apparently when the sleeve of tissue that the tendon is covered by is intact then the severed ends of tendon should meet. MRI’s would be great, but can’t see it as an option for most NHS ATR’s!
Can’t vouch for other conservatives, but about 4 weeks in I “felt” that a connection had been made. As well as the foot twitches there was a tug between instep and back of heel . I still get that when foot is elevated.
2 weeks in the boot and still not convinced about puttining all my weight through it. Once crutch ain’t so bad. Also still waiting for a physio appointment… try and get your consultant to get you in early. Very frustrating,
Bernardhg // Sep 5th 2008 at 12:46 pm
Thanks for the reply… the second consultant i saw in the fracture clinic said he could see that tendon sleeve is in place… so my choice of non-surgery was possibly a good one.
Richard // Sep 14th 2008 at 4:26 pm
Hello,
Just catching up - How’s the boot going and recovery in general?. Who said Peterson couldn’t do it!! - I’m a week away from hopefully better news (still in equinas 9wks!!)and a foot move - fingers crossed
Richard
uknodger // Sep 15th 2008 at 2:16 am
Fingers and toes crossed for your good news. Proper post to follow. Had a long NHS admin induced wait for physio. Turned up with one crutch and boot and she raised an eyebrow suggesting I was being reckless. Few days later I was ticked off by fracture clinic for still using a crutch… told to try shoes with wedges, with caution. Going to do a few more days with just the boot to build confidence and strength, and then try the shoes. A strange flurry of “progress” after 10 weeks!
jonathan9 // Sep 15th 2008 at 3:54 am
Hello UK,
I’m in non-surgical and never had a boot and was told I would get no NHS physio.
I’ve now got a private physio and the progress is quite impressive, even after a week.
Get as much physio as you can out of the NHS if you’ve been given it as some of us aren’t so lucky.
Speedy healing,
Jon
uknodger // Sep 15th 2008 at 10:19 am
Thanks Jon. Glad your physio is working, though it is a shame to not get any on the NHS… even more surprising to go from cast to shoes with no boot. Having had 4 different consultants look at my ankle or cast, it is obvious that there is no standard way of fixing this. I have been thinking about a few sessions with a private physio, but will have to wait to see what the promised Lower Limb Club is like.
Bernardhg // Sep 16th 2008 at 10:48 am
at 5 weeks…..i have just been to the clinic today, and they have raised my foot up a bit… to a 30 degrees…. and put on a new cast….. seems to be healing… surgeon was better this time…. i will be back in two weeks to adjust the angle further….. surgeon stated it was a full rupture
uknodger // Sep 16th 2008 at 11:24 am
Congrats… that sounds like progress by the text book. Not sure that many actually get the two weeks per cast. I started to feel as if there was healing taking place at around 5 weeks too. You should be over half way to being out of plaster!
Bernardhg // Sep 17th 2008 at 8:14 am
Thanks….the surgeon said he did not need to see the exposed foot…. which i thought was strange… however the plastercasters each have over 20 years experience each…. so i am assume if something was amiss they would have called the surgeon…. i now have a pulling feeling at the back of my leg… which i assume is the tendon stretching
Bernardhg // Sep 30th 2008 at 5:50 am
Just come back from the clinic….. they have now recast my foot at almost 90 degrees (85 degrees)…… surgeon wants me to come back next week to remove he cast completely…. that will make it 8 weeks since full ATR
bernardhg // Oct 7th 2008 at 4:29 am
I was given no moon boot…. but a come back in 2 months after physio…. these NHS surgeons surely do not talk to each other…… anyway I am glad…… and know I will need to take carefully
uknodger // Oct 7th 2008 at 4:48 am
That sounds like you are on for slightly early mobilisation for a conservative… 9 weeks from ATR to being cast free and walking. Take it easy… I have “turned” the ankle a couple of times and had a small stumble. Discomfort has really been from swelling and joint pain from lack of use,only a few twinges in the tendon… and that could be the cold and damp.
bernardhg // Oct 7th 2008 at 4:52 am
Thanks for the advice…. I will certainly take it easy…. although I still need to work … and do those site visits…. hence the site boots with high angle protection etc…. will come in great use
dazf // Oct 7th 2008 at 3:10 pm
Fellow UK sufferer here,
Is it common practice for NHS to give us a boot or does it differ from area to area?
My page to say hello to fellow UK NHS sufferers.
http://achillesblog.com/dazfones/uk-atr/
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