two shoes question

I’ve been reading a lot of these blogs recently, but am not sure I’ve ever seen anyone say what criteria their doc/PT use to determine when they can move to two shoes.  I know there is a wide range of rehab protocols among site users, but I’m wondering what rationale(s) drives the decision.

thanks!

Carol

5 Responses to “two shoes question”

  1. I’ve never heard about anything except calendar/protocol and judgment/guesswork. I’ve also never seen a published report that documented good results using a flexible patient-specific protocol. The best results so far have come from one-size-fits-all protocols that move fast. So far. Lots of OSs probably think they know better, but most of them don’t even keep records of their results — and it’s easy for them to blame reruptures on stupid non-compliant patients rather than stupid rehab based on guesswork and ignoring the best evidence (so far). My $0.02, obviously.

  2. Hi Carol,
    We had basically the same surgery although I did not have any bone spurs. I completely tore my Achilles off my heel bone on August 2nd. I has surgery to reattach on 8/14. So here I am 5 weeks out with a completely healed incision and a stubborn tendon that I am trying to stretch out. My surgeon keeps telling me to take it easy…that he’s concerned about the sutures holding the tendon to the bone. I have two PT sessions under my belt and the OS finally said I can partially WB. He doesn’t know that I have been walking in the boot full WB yet. Not all the time, but I can do it. How quickly did your OS allow full WB? Was he ever concerned about your sutures? Mine told me that the protocol rehab for surgeries like ours is that there really isn’t one. I know my surgeon is one of the best here in SoCal, however he is a bit conservative. Norm? Any input?

  3. Steve, I wrote a fairly long reply on my phone, but it doesn’t seem to be posted here. I think my OS is on the more aggressive side of the spectrum, based on a very unscientific sampling of posts on this site. I was PWB in a boot at 12-days post op (though very P early on!). At my second post-op appointment, I was told I could go FWB as tolerated; five days later I had ditched the crutches. I have my third appointment on Friday. It will be just over 7 weeks, and I expect my OS to tell me I can start transitioning to two shoes. The Exeter protocol, which seems to be the fastest one anyone here really talks about, has people moving to two shoes at week 9. My OS seems to be treating my rehab and progression as if I were an ATR instead of a chronic insertional tendinosis with Haglunds’, etc. — or rather, he seems to be treating them the same.

    One of the few things my doctor was adamant about was no PT until he’d seen me at week 4. I know he used bioabsorbable suture anchors instead of the metal screws that some surgeons use; I’m inferring from the no-PT period that he is confident enough that the anchors and the sutures attached to them had “set” long enough to withstand a typical achilles rehab program. He did not send a specific protocol with me to PT (and, unlike ten or twenty years ago, could not designate a PT clinic that I had to use/was strongly encouraged to use). Again, I’m inferring here, but his lack of specific instructions seems to me to suggest that he’s comfortable with the status of the repair/tendon transfer. I’ve worked with a lot of OSs over the years (I used to work in sports medicine) and I’m very confident in the quality of my doctor; he came very highly recommended.

    I would be (and am!) pretty cautious about stretching. I do active ROM exercises and the PT does some very gentle passive ROM exercises with me, but no one has suggested any kind of real stretching at this point. It feels tight when I cheat and walk w/o the boot, but I’m willing to be patient and work on strengthening and more ROM (though mine’s close to normal) before I get more aggressive with stretching. (okay, so this is a long reply, too;

  4. Hi There,

    Thanks for the quick reply. My surgeon was basically the same. At my week 4 appointment post op, he said to schedule PT the next week and he would not see me for another 4 weeks.

    I know I have 5 screws (4 for the achilles and 1 for the transfer) I’m not sure what he used though. I guess the goal at this point is to get my foot to neutral because until then, walking is a moot point. Hopefully in the next few weeks!

    Good luck with your rehab!

  5. Steve, many successful ATR protocols — including bit.ly/UWOProtocol — prescribe FWB boot-walking before the ankle angle reaches neutral. And many of us walked comfortably and FAST in a boot while still plantar-flexed. The only challenge is to build up the height (and maybe angle) of your other foot to match, so your hips are straight. Otherwise you risk damaging a number of other body parts, as well as learning to walk off-kilter in ways that will have to be UNlearned — sometimes way harder than it sounds.

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