6 weeks Post Op and FWB

April 5, 2013 | |

Just a quick update on my status. I’ve reduced the angle on my boot from 5deg PF to Neutral as of last night. It was a bit tight as expected this morning at the tendon and calf but it’s starting to feel better as the day goes on…

As of a couple of days ago I am FWB. I increased the weight on the injured leg through the last week or so and one day found that I could “balance” on it for a second or so at a time if I leveled up. I’m still working on my gait, but it’s nice to be crutch free. I still take the crutches with me outside just in case, and I have them by the bed in the morning because it takes me a few moments to let my foot learn how to bear weight (it has short term memory I guess).

Even though I’m at neutral, I’m still using the “Wedge” rocker sole on the Vacocast. The flatter sole, which OPED still calls a “Rocker Sole”, is a bit too flat feeling and I cannot roll on it comfortably. It also feels like OPED’s definition of neutral is not really neutral. I put the flat sole on and even up the other leg and I can see that the foot/leg are not at 90deg. Anyway, I think I will work on the gait with the easier wedge rocker sole for the next few days and then move on to the flat sole so that I can be balanced better with the other side. I’m using old Teva’s inside the house with modified height. For outside I’m using a few foam inserts along with a 3/4 gel insole to raise it up in a leather boot. It’s not quite level but almost there. Again, moving from the wedge sole to flat rocker sole will help.

I have a PT appointment coming up on Monday…it’s supposed to be an evaluation only, but I’m glad to get started. Since I’m deviating slightly from the Doc’s orders, I will make sure I crutch in to the office. (The doc said to start weight bearing at Wk6, though, so I am not too far off from his protocol.)

Also, another flight coming up for me on Tuesday. This time it’s a business trip so I won’t have my wife’s assistance. I’m bringing the crutches for the sympathy vote at the airport security lines but was also considering the knee scooter to get around the airport. Walking lengths at airports can be very LONG so it might help to have the scooter… The sad part about it is that it’s a conference at Deer Valley and I was hoping to get some spring skiing in before I had this injury. Oh well!


Comments

21 Comments so far

  1. normofthenorth on April 5, 2013 1:45 pm

    It all sounds good to me. Try to avoid DVT on the flights.

  2. trin74 on April 5, 2013 1:46 pm

    I have been FWB since Sunday (6 weeks from injury yesterday) and I have also found it hard to walk in the flat sole. So can totally sympathise with you there! My physio watched my gait in both the rocker and the flat sole, and came to the conclusion that I am hyperextending my leg due to weakness of the quad and knee… She recommended to remain mostly in the rocker sole and use the flat sole around the house where I can really concentrate on keeping my knee bent and walking slower. I am quite good now at walking with the rocker sole, although I get a bit tired by the end of the day. It’s so nice to be more mobile! I have a walking stick that I can fold up and put in my handbag for when I need to use it, so don’t have to lug the crutches around anymore for the just in case! Good luck with your healing - will keep an eye on your progress being the same time as mine.

  3. yakswak on April 5, 2013 2:09 pm

    Norm: Thanks! I’ll take precautions as last time…Asprin 2x per day 2 days before, during, and after the flights. Since I’ll be flying at least once per week in the next 4 weeks I might be taking it all the time now. I’ve got a lot of business travel backed up, but I’m going to tackle them slowly (no 4 or 5 day “tours” for a little while)

    Trin: Thanks for the comment and encouragement! Are you fixed at neutral or are you hinged? I’m thinking the flat sole would be easier to use in hinged mode but who knows, I’m not ready to try that for a while. I’ll use your PT’s suggestion and try the flat sole in the house every once in a while…

  4. yakswak on April 5, 2013 2:43 pm

    Trin: By the way, where did you pick up the folding walking stick? I guess I’ll check out REI or something…

  5. trin74 on April 5, 2013 4:11 pm

    I find it easier to be fixed actually with the flat sole, and I am hinged in the rocker. When I’m in the flat and hinged, the foot almost wants to go into a planterflexed position when I go to step, which makes it harder… So keeping it fixed for now until I get my gait better. You may find it different, but that is what works for me with minimal stress on the Achilles. Oh, and I got the walking stick from Argos for like 12 pounds. Score! It’s adjustable for height as well. I’m sending my knee scooter back next week - that thing was an absolute lifesaver.

  6. normofthenorth on April 5, 2013 4:33 pm

    Yakswak, I had more in mind drinking water and walking around on the plane to minimize DVT risk. Most experts say that NSAIDs (pres. incl. Aspirin) are bad for healing tendons. I don’t know the evidentiary or clinical basis, but it’s widely said and very likely true. Way easier to take and cheaper than LMW Heparin, though… You might ask your Doc if there’s something else that works.

  7. yakswak on April 5, 2013 4:34 pm

    Trin, Ahh, I didn’t think to look outside of sporting goods stores. They’re $60+ at REI! I looked on Amazon for a folding cane and see that there are several around the $10-12 mark. I wonder how long I’ll need a cane or support “just in case”…

  8. normofthenorth on April 5, 2013 4:38 pm

    Typically cane or 1-crutch time doesn’t last long before you forget where you left it. Then it’s handy in public for a while to ward off people who might trop or kick you — or at least to smack them if they do! ;-)

  9. yakswak on April 5, 2013 4:39 pm

    Norm,
    Yeah, this is what my doc recommended I do. Of course, moving my leg and getting up on the plane as well. We have talked about NSAID’s at our clinic visits so I think that he thinks the risk of DVT outweighs any negative implication to tendon healing. He seemed very sensitive to the risks of DVT while flying and said he also does the same thing (prophylacticaly taking Asprin).

  10. Lisa on April 5, 2013 6:22 pm

    I have a question. Does the Vacocast, or any other boot, really allow you to be FWB? Isn’t it taking some if the weight off the Achilles? I think I’m mostly asking because I’m not sure if my not wearing the boot at home would add significantly more “weight” bearing or if its just for protection.

  11. normofthenorth on April 6, 2013 3:02 am

    Lisa, FWB in a boot should put NO weight (or “load” or tension) on your AT. FWB just means your leg is carrying your full weight. Walking out of a boot starts loading up your AT. Most protocols have you load it up more gently forst, with Therabands or towels, or a hinged boot…

  12. Eyechilles on April 13, 2013 10:16 am

    Hey Yakswak,

    Hope the traveling went well. I used 2XU race recovery compression socks for my recent trip to Europe including an eleven hour flight to Rome in addition to the 2 aspirin, hydration, and moving around and the socks really helped keep the swelling down. They were not much fun to put on or take off though.

    I was wondering about your progress and specifically you current vacocast settings. I’m on Post Op week seven now and FWB off crutches finally with the big wedge sole hinged at 5 to 30 degrees plantar flexion. I’m still working on my gait and hoping to switch to the flat sole soon and then try to get into two shoes finally. Any advice?

    Thanks

  13. yakswak on April 13, 2013 10:53 am

    Hey Eyechilles

    Glad to hear your trip went well and you are moving along! I’m at a fixed 0deg setting in the boot and using the flat sole as of yesterday. I will also be hinging soon but didn’t want to introduce two new things at once. I can walk fairly fast now and kept up with folks at the airport in my trip this last week to Utah and back. Flat sole took a bit to get used to but the principle is the same…I just have to be more committed in putting weight on the shin to get proper roll and push off from the boot. The big wedge sole almost does that for you which is nice, but I’m enjoying being back at a more normal height.

    My transition to two shoes may take longer than you as my doc is conservative. But I’m working with a PT since last week and she and my doc communicate regularly. I did some out of boot weight bearing exercises yesterday and am trying to strengthen my legs to get me ready for the next step.

  14. Hillie on April 13, 2013 12:41 pm

    Your doctor appears to be, as you say, conservative in his treatment (but he has seen you, I haven’t), and he is not making best use of the boot’s design - it would have helped if after week 4, you had the boot set with a rom (i.e. hinged) of 30ºPF - 15ºPF and the flat sole attached.

    This gives a more natural gait without having to think too much about rolling and pushing off, and helps to even up the 2 legs - takes maybe a few hours to get used to it but it works for most, especially when they have the confidence given to them by full weight bearing a week or two earlier.

    At neutral (by which I mean a rom of 30ºPF - 0º) and with that flatter sole, walking should really be a piece of cake, and in another week or two you could have a rom of 30ºPF - 10ºDF, setting you up perfectly for the transition into 2 shoes. By all means, keep a crutch or stick handy for any crisis of confidence which you probably won’t have but which will act as your “don’t crowd me” warning.

    By the way, ‘personal’ question, do you still wear the boot in bed?

  15. yakswak on April 13, 2013 1:46 pm

    Hi Hillie

    Thanks for the post! I am still sleeping with the boot in bed. I don’t mind it by now and it makes the mornings easier I imagine.

    Doc definitely does not know about the hinging feature. I’ve been trying to balance full compliance vs “what I’ve read on the Internet” (although this includes peer reviewed journals). The real life experience from users on this site have been very helpful!

  16. Hillie on April 13, 2013 3:14 pm

    There is a little green booklet supplied with the boot plus PDFs and videos online. Did your doctor prescribe the Vaco boot or did you buy it? Worrying when a specialist doesn’t know how a leading technical product that a patient is using actually works. By the way, not wearing it in bed is great, after having it on all day. Remember too what I suggested about prepping for 2 shoes and how much easier it will be for you if your AT is prepared for it. My protocol was given to me by an ortho specialist and reviewed fortnightly by the physios - and it worked perfectly. This time last year I was 6 weeks into it.

  17. yakswak on April 13, 2013 3:56 pm

    Yup, provided by Ortho (although they had a med device distributor come and fit me). I’m pretty sure he thinks of it just as a boot that you can adjust angles on without the need for wedges.

    I got the booklet and PDF…the patient (me) knew what it could do but they did not.

    Yup, hinging it was going to be my next step…again, one change at a time.

    What was your protocol if you don’t mind sharing?

  18. normofthenorth on April 13, 2013 11:36 pm

    I waited ’til 7 weeks in before I started hinging my hinged boot (different brand), and I never felt comfortable with it hinging past neutral into DF, so I never left it there.

    Around here (Toronto), some cheap discount stores carry telescoping walking sticks, with a little spring-loaded “shock absorption” built in, dirt cheap like <$10.

  19. Hillie on April 14, 2013 6:46 am

    Yakswak

    Here is the basic protocol - I stuck pretty close to this but we were able to bring some parts in early, such as Theraband and static bike.

    Week 0 – 2 Consultant and physio. Full equinous (toes pointed down) lightweight splint. Non-weightbearing + crutches or frame. May use toes to balance.

    Week 2 – 4 review (i.e. beginning of third week). See physio. Into Vaco Achilles boot set static at 30º PF. i.e. toes still pointed. Wedge sole, this period only. Able to weight bear, can wean off walking aid as comfortable, probably use outside. Wear boot at night. Can remove for very gentle ACTIVE exercises.

    NB It is only in the first 4 weeks that the leg and foot are in a static position, with no range of movement (ROM). After this, the ROM steadily increases. Remember, this is an adjustable, hinged boot, no internal wedges.

    Week 4 – 6 review. See physio. Boot ROM 30º PF – 15º PF. Flat sole for the remainder of the boot wearing. Mobility improving. Can remove boot at night. Increase number of sessions of exercises.

    Week 6 – 8 review. See physio. ROM 30º PF – 0º (neutral). Theraband exercises (possibility you start earlier as I did).

    Week 8 Patient to adjust at home. ROM -30º to +10ºDF.

    Boot ROM is now hinged to ‘step-through’ walking. May start gentle swimming if safe to get in and out of pool without using rung ladders. No pushing off from sides.

    Week 9. Shoes ok indoors with heel pads (supplied by physio at week 6).

    Week 10 See physio. Out of boot indoors and out. Use heel pads as comfortable. Can take boot out too as a precaution if desired or ‘hazardous’. Should be able to drive within a couple of days of being in shoes if you can do an emergency stop.

    Increase exercise tolerance with gentle and frequent walks, cycle, swim.
    Arrange for additional physio work in coming weeks if required.
    Start to increase exercise tolerance, concentrating on non-impact, non-explosive activities, such as swimming, walking, static bike or bike on the flat (nothing strenuous).
    Aerobic gym work as comfortable e.g. x-trainer, treadmill walking, stepper (you may not be able to do some of these).
    Not running or jogging for 4 – 5 months post ATR.
    OK to make the calf ache, but rest before carrying on. Change activity frequently to avoid fatigue and rest when and if you get tired/ache or ‘burning’ feeling around injury site.

    For 6 months after injury due to the potential risk of a re-rupture, not advisable to:

    • Play explosive sports e.g. squash/ badminton
    • Do maximum resisted weight work for lower legs, or use rowing machine
    • Go up and down rung ladders
    • Horse ride (as heels go down in stirrups)
    • Do loaded passive stretching of calf (heel hangs on step)

  20. Eyechilles on April 15, 2013 12:41 pm

    Hillie: Thank you so much for sharing your protocol. I saw it posted elsewhere and it motivated me to start hinging my boot earlier which has really helped with my gait. My surgeon is really conservative and not familiar with the vacocast which I bought on my own after seeing it on this site. Its been really helpful in my recovery. I start post op week eight tomorrow and will move to 0-30 degrees PF. Next week I will open it up all the way. I am still having trouble getting into the flat sole because I cannot get my heel down at the beginning of each step in that thing!

    Yakswak: Thanks for the update and glad to hear you are walking so well in the flat sole at zero degrees! Please keep us updated about your progress and PT work if you don’t mind. I start my PT tonight and can’t wait!

  21. yakswak on April 15, 2013 5:28 pm

    Yup ill make a new post about PT soon.

    Flat sole transition was easier than expected and I’ve opened my ROM since the last posts from Hillie as well. I am working on the green Thera Band for strengthening my calf but my calf is so weak I’m not really working them when I walk. Still letting the boot do the work through weight transfer on the shin.

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