Four-week post op visit

I had my four-week post-op/second post-op visit today and am very pleased with how it went.  At my last appointment my OS had told me to wear the boot only for practicing walking, so at home I rarely wear it.  At work, though, I have it on even when I’m using the scooter, mainly for protection/security.  Thirty minutes into my 3 hours of teaching, my incision would begin hurting, despite the fact that I was always in a chair with the leg propped up.  I had planned to wait until this visit to discuss the vacocast with my doc, who wasn’t familiar with it, but decided not to wait, and ordered it Monday.

The boot arrived on Wednesday and Thursday’s teaching was so much more pleasant; I had the boot on for about six hours without pain.  When I wore it to today’s appointment, the first thing the nurse said was, “Wow!  Cool boot.”  I started explaining all the features and handed her the pages I’d printed for the doctor.  As she was leaving the exam room, she saw him the in hall on his way to see another patient, and insisted he come check out the boot.  He seemed impressed, though really didn’t have time just then to really check it out.  I hope he looks up all the information I gave him, as the nurse said the vacocast cost about the same as the boots they currently use.

I had forgotten at my last appointment to ask him about the condition of my achilles.  I had assumed that less than 50% was in decent shape since he went ahead and did the tendon transfer, but today he said it was in really bad condition — which makes me regret spending as much time as I did listening to the first OS.  Oh well, lesson learned.

He looked at the incision (it looks good), watched me do a couple of seated calf raises (I can get my heel about 4cm off the ground), gave me a choice of whether to do rehab on my own or with a PT (I chose the PT), and told me I can start FWB as tolerated!  That’s exactly what I was hoping for.  On the other hand, I don’t see him again for 3-4 weeks, so unless the PT makes the call on two shoes, I’m in the boot until Sept. 20.  At least it’s the vacocast.

I celebrated by having the friend who was driving me drop me at the gym so I could work out on machines and with heavier weights than I have at home.  I was cleared at my last post-op appt to ride a stationary bike as long as the resistance was set to zero.  I figured today  that if I’m allowed to start working on FWB, then I can also increase the resistance on the bike; I set it at my pre-surgery level but lasted for only five minutes before my achilles started getting uncomfortable, at which point I cut the resistance in half.  Still, it felt so much better than pedalling with no resistance at all.  Because I’m not FWB, I used machines for lower body work, using both legs for leg raises, but only my good leg for the hamstring curls; the bar hits right about where  the incision is, and I decided to play it safe.  I’m tired now, but in a good way.

I’m now investigating PT clinics in the area.  I’ve been to two here in town, including while I was trying to rehab to avoid surgery and they’re fine, but am hoping to find one with hydrotherapy and a PT who is willing to use it; I’d do that part on my own, but the pool at my gym in an outdoor pool and will close for the season soon.

I’ve got the vacocast at 5 degrees plantar flexion but cannot do FWB at that angle; I was guessing at the 5-degree angle to begin with, since I didn’t know how to translate one wedge+plus leather top into an angle; it feels fairly close to where I was in the old boot, though.  Should I try increasing the angle to 10 deg. and trying FWB, or stick with the 5 deg. and use the crutches more until it’s more comfortable?  It seems like I’ve read that some people are FWB at 15 deg. or more, but don’t know whether that’s an approach that’s widely recommended.  Any and all advice will be welcome!


14 Responses to “Four-week post op visit”

  1. Hi…. I’m 1 week behind you. I get out of my cast next week and I also bought the vacocast. I think I read that 1 wedge is 10 degrees.

    If you put the bottom lock anything higher than 10 degrees, you have to use the thicker sole. They have a lot of videos that go over the various intricacies of the boot. I’m excited to put mine on next week, just concerned about evening up.

    I reruptured in the aircast because of the wedge so I refused to go into a boot with wedges. I was hoping the doctor would order the boot for me, but no such luck.

    So are you driving?

  2. Hi Upstate,

    I suggest not pushing the resistance until you are cleared by the PT. I was FWB for a few weeks before I was allowed to put resistance on a bike.

    Just a thought,

  3. superjewgrl — Thanks for the info about wedge angle; I tried measuring the sides and figuring out the angle, but even with the help of the internet, my geometry skills are so ancient that I wasn’t sure how close my calculations were. The left-foot accelerator was delivered yesterday and a friend will install it for me tomorrow. I plan to practice the rest of the weekend before deciding whether to drive to work on Tuesday.

    brokendad - were you riding in your boot? I am, and was thinking that even with resistance I would be exerting less pressure on my ankle than when walking. I’m not sure I’d try riding without my boot now, even without resistance. If I’m way off base, let me know. The last thing I want to do is cause damage!

  4. Hi Upstate,

    My Doc and PT said no resistance while I was in the boot and a couple of weeks after. I believe I was out of the boot at about five and a half weeks and allowed to start resistance at about eight weeks. The PT wanted me to be able to do double leg heel lift prior to the bike and single leg lifts prior to jogging.

    Please don’t let me discourage you,

  5. Upstate, I waited til I was 100% solid FWB in my boot then started riding a REAL bike around town. As much resistance as … riding a REAL bike around town! After I went to 2 shoes, I think I used the boot for cycling for a while, then favored my heel. A few weeks later, when I was pedaling on the ball of my foot, potholes were a shock…

  6. brokendad, you’re not discouraging me; I’m taking your advice as a reminder not to go too fast. I’ll trust the signals my leg is sending and adjust accordingly. I just need to remind myself that there’s a reason the progress chart on the blog is a 365-day marathon.

  7. SJG, I hope your nasty experience is making people cautious but not scaring them off the AirCast and other boots that do a good job with heel wedges — and proved it in the UWO study. Heel wedges need to be glued in place and usually come with peel-and-stick 2-sided tape on them. Your pros didn’t peel and stick yours, with tragic results. But a human can also mess up the angle on a Vaco boot. Edward Teller once said “there is no foolproof system, because the fool is always greater than the proof!” So find good pros, but don’t assume that they’re perfect, either!

  8. Upstate - my cousin had told me he was on the spin bike 9 days post op! WHAT! So at about 21/2 weeks feeling like it was not going to be possible I “hopped” on! That first time I literally rested my boot on top of the clips and with no resistance I just let my bad leg go along for an easy ride. I think it is soooo good for the body to get the blood flowing and it made me feel so much better. I sort of forget the progression but over the next 4 weeks or so I got to where could actually ride hard enough to sweat and get some exercise. I was able increase the resistance slowly but mostly I would just spin as fast as I could without my boot flying off the pedal. (This did happen a few times!) Also I was allowed out of the boot at 6 weeks so I would ride for exercise with the boot and then ride without the boot REALLY slowly with no resistance. I let pain be my guide. I think somewhere around 7 or 8 weeks I could do the whole ride naked! :)

  9. Norm.. You are so right. I am one of those humans who messes up a bunch of stuff. However, now that I’ve ordered the vacocast, I really can’t understand why everyone isn’t prescribing it. Since Kobe used it, maybe it will get more visibility with US doctors. I will be bringing it in to my doctor when I get my cast removed, so I figured I should read the directions and know the instructions so I don’t have to rely on someone educating me on things I don’t know to ask about.

    Norm no doubt, you are way more knowledgable about this than me. I also have a TON of respect for you and your guidance. I’m sure the aircast does do a good job. I personally just would’ve preferred having a choice offered on what boot I was put in and the pros and cons of each. Had I not reruptured, I would be oblivious to all of this.

    BTW, I read that Tiger Woods ruptured in 2008 and used PRP injections and the hyperbaric chamber. Take Care.

  10. To add to what Norm said about wedges etc, my Aircast boot had wedges in the heel that were so securely taped together that I needed a fair amount of strength to prize them apart when removing one.Although I totally understand sjg wanting to do things completely differently second time around, I probably would myself .

  11. I also think norm is amazing. The aircast may very well achieve same ultimate result.

    However, for me, once I put on the vaco, the aircast seemed to double up as a torture device in addition to a healing device. The immediate difference was that drastic. By that time I had also had the aircast removed, stitches removed and reapplied. So I was fitted more than once.

    After my experience I put little to no weight in that docs still prescribe. The medical system in many places despite wonderful people is stuck in the dark ages because of arrogance and greed.

  12. sjw, my first OS wanted to use PRP on me instead of surgery, so I did a ton of research on it; Tiger and Kobe both used it for knee injuries, but the science is still out on it. There are so many unknown variables at this point, that even if my insurance had covered it, I wouldn’t have tried it.

    I tried driving with the left-foot accelerator this afternoon. I drove around my neighborhood, with a friend in the car with me, in case of problems, for about 15 or 20 minutes before venturing out into a busier area to get air in my tires — presumably the result of the car having sat in the driveway for four weeks. It went well, but I plan to practice several more times before deciding when to drive and when to look for rides. I drove a stick shift for decades, so using my left foot isn’t totally foreign to me, but I still want more practice before I’m totally comfortable.

  13. Bionic - 100% agree.

    Up - Good luck with the driving and your healing. Keep us posted. I’m rather excited for you.

    Take Care.

  14. Upstate,

    I know it’s hard to take it easy. Just remember you will be running again, just not today.

    Take care,

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