Mar 03 2010
2 Shoes @ 6 weeks
Had my second PT visit yesterday. After a variety of stretching, massage, ROM, electro-stim, and standing exercises, I was able to walk (limp) around the room without pain and an extremely tight AT. The AT was still very stiff, but it seems to "loosen" slightly each day as I do my assigned exercises at home. Ortho told me to ditch the boot today in favor of a sports ankle brace.
So, I guess I’m officially in 2 shoes, perhaps with an asterisk?! Certainly not running, and I’m walking with a limp, but it’s nice to be free of the boot. Still a long road ahead, but this is progress nonetheless. Seems like the PT will be important in getting the AT loose again….another visit tomorrow.
I bet a lot of us had to use some judgment in picking an exact date for “2 shoes”. I posted a blog entitled “I’m calling myself in 2 shoes now” or some such, because it was borderline. (I was alternating between lots of Crocs at home and always a hinged boot when I went out.)
Don’t forget to be careful! No distractions while you’re walking, especially on stairs or rough surfaces or tight quarters!
Great news….take it easy and be careful when out and about!
Norcal,
If I may ask, what are the exercises you have been given to stretch the AT, and how is flexibility being measured?
Congrats on the two shoe status.
Just take things slow and do everything the PT tells you.
Remember…”Slow and Steady Wins THIS Race”
Peteco,
I’ve been given a few exercises to do at home:
1) toe curls while sitting
2) sliding the foot back while sitting to stretch the AT
3) lift the toe up and pivot the ankle while keeping the leg still. Pivot from the knee while sitting
4) balance on the foot while holding on to a counter or table
5) lean against a wall and slide up and down while keeping knees bent around 90 degrees
6) hip scissors (for strengthening the hip flexors). Lie on side and raise the leg up in scissors form.
The PT is just now beginning to measure how I’m progressing simply by ROM. I started at 0 and am now getting to +10 (on plantar flexion (toes up). I go back again today, and may do some pool exercises.
I can do most of these without pain, the AT is tender and tight. All normal from what she says. I was surprised how poor my balance was on the “bad” foot. I was unable to balance - had to hold on to the table!
norcalsurf, I’m pretty sure you DID mean “(toes up)”, but you DIDN’T mean “plantar flexion” (which means toes down).
So your AT and calf have loosened up enough that you can now dorsiflex 10 degrees past neutral. Good stuff. The exercises sound good, too.
It is amazing how much we lose the muscle control and the “proprioception” that allows us to balance on one foot. Part of it is surely from weakness (atrophy) of the smaller muscles that do things like “inversion” and “eversion” (and that generally stabilize our foot and ankle joint) to correct a bit of imbalance.
But part of it also seems to be from atrophy to the “control systems” that translate a little bit of off-balance into a little bit of (quick) correction.
The nerves in our foot help us sense when we’re a bit off-balance, as do our inner ears and our eyes, etc. The nerves in our “bad” foot are wrecked by weeks of non-use and swelling (and maybe surgery, too), and even the other circuits may be “rusty”.
Anybody who’s ever tried to balance a broom (or a sailboat mast!) vertically learns that an ounce of prevention is worth a pound of cure — it’s best to correct tiny errors instantly, rather than to wait for them to grow. And during this recovery, that talent seems to vanish from our “bad” foot, and needs to be restored.
Interestingly (and depressingly), I’ve read that the ability of “normal” people to balance on one foot with their eyes closed is amazingly well correlated with physical age, regardless of athletic ability, training, participation in balance-related activities, etc. There’s some formula — stand in a doorway (for protection against falling), stand on one foot, close your eyes, and time the seconds until you “lose it”, then multiply by “X” and add “A” to find your age in years, and it will be amazingly close, even if you think you’re very special!!
Norm,
You are correct on the dorsiflex/plantar flex thing. I’m not up on the technical jargon quite yet!
Forgot to mention that the PT measured calf circumference and I’ve lost 1.25 inches in my 6 weeks off the bad wheel! I’m sure the quad is smaller as well.
Much appreciated Norcal (by the way, I went to high school in Palo Alto and college at Cal). How much of a “stretching sensation” will your PT allow? That, I think, is the last frontier for me in order to walk normally. Since my doc doesn’t want me walking outside the boot at all, I have not been pushing that stretching sensation much at all when I am walking barefoot, lest I re-rerupture and feel really stupid. Did your PT do any tests to determine that your AT is “ready” for all of these activities, or was it taken on faith based on how long you are past surgery? Man, I would love to hop in to my ortho appt on the 15th on my bad leg wearing flip flops….
Odd development today…a close relative of my wife ruptured today…I will be pointing him to this site if he calls.
Peteco,
I asked about how much “stretching sensation” I should be getting during the exercises and it’s fairly arbitrary, really until “I get a good stretch, and when I can’t go any further without pain” was the answer.
To determine my readiness for PT, the Doc and PT performed similar tests during my visits on ROM and flex and after massaging the AT, they felt I was ready to begin. Again, not sure if there’s a scientific formula to determine when the AT is ready. If there is, I’m not aware of it.
My PT did give me a way to measure my dorsiflex (toes up - thanks Norm!) progress, however. Simply place your toe against the wall, crouch down and try to bring the knee to the wall. My good AT of course, went right to the wall. The bad one, I was 4 fingers width away.
Did some pool work yesterday at PT - walking and stretching in the water. Good stuff. Progress is slow and I was a bit sore after all the PT work with week, so I’m taking a rest for the next few days…don’t want to overdo it.
Seems like you are ready to get going on PT, are you able to do some of the exercises I outlined above?
1) This whole question of how much and how soon to stretch (dorsiflex) our ATs is a fascinating one. Obviously, the whole ankle usually starts out stiff as a board, and has to regain the ability to dorsiflex normally before we’re back to normal.
On the other hand, I’ve been playing “killer” volleyball with on AT that was repaired a bit on the short side, and I’ve been laughing.
But there are a few people on this website who’ve somehow healed up with a LONG AT, and they’re not laughing at all. Some have had, and some are now contemplating, corrective surgery, with a LONGER rehab time than we’ve been going through!
So at 12 weeks in, I’m being a little on the “wimp” side of the stretching exercises my Physio just gave me. Working harder on the strength exercises, I am.
2) Peteco: Call up your relative-in-law yourself, and share your info and links! And give me and my blog a chance to talk him out of the surgery! Just because the new revelations and evidence haven’t yet blanketed Boulder or the rest of the US, that doesn’t mean he’s got to suffer with rashes and incisions and (God Forbid) infections! Extra pain, too, and risk of DVT. . .
Norm,
He never called and I think his surgery was today. Oh well. I think he lives in Indiana or Ohio so soon we may know how they deal with things there.
Norcal,
I can do all of the exercises you mention (though without PT supervision, how do I know I am going them correctly), my problem is I don’t know how far to push anything given that I am not officially cleared to do anything. I can stand on the bad foot without holding on for 5-15 seconds or so, but I don’t want to push that and risk falling forward. And as for the stretching sensation, I don’t want to push that for fear that the pain threshold might be the snapping threshold. I am not allowed to go in the pool due to my ongoing rash saga either. I tried the stationary bike the other day and that is fine…but I was using the middle of the boot not the toe area…not sure what the protocol is there. Bottom line for me is that I am just going to keep walking around barefoot and hope that keeps me ahead of the game (whatever game my doc has planned) with respect to AT strenght, calf strength and general ROM. I might try that wall thing if it doesn’t stretch me out too bad. Will let you know what happens.
Peteco,
As far as the stationary bike goes, you are right using more of the heel to pedal - that’s what my PT also said I could start to do. I also asked about other exercises that I could do to strengthen the quads. Really, at this point there isn’t much. She doesn’t recommend leg extensions (they are bad for the kneecap). So at this point I’ll stick to the bike, normal upper body weight training (dumbells, push ups, abs strengthening), and swimming for cardio exercise.
norcal,
on the bike, are you in or out of the boot?
i just tried that wall thing…don’t know if I am doing it right but I am nowhere near 4 fingers…more like 4-6inches I would say. What do you mean by crouch down? I haven’t put on my boot in a few days (work from home) and that tends to loosen/warm up the AT, but I doubt I can get very close anyhow if I am doing that test right. Like I said…I think my AT is tight and I am afraid to stretch it to near pain vs. stretchy sensation….
hey Dan,
great party! i’m walking on 2 feet w/o boot, slowly, but walking. i actually walked with two shoes today…exactly 5 weeks post-op. i swear the PRP injection has helped the healing dramatically. i see the surgeon on thursday, hoping he gives me the green light….or else!
talk to you soon, heal up!