Posted by: andy1000 | October 23, 2010

First Physio Session 8 Weeks Post Op

Had a 40 minute session with PT courtesy of the NHS. He has given me a bunch of excercises to do to improve ROM. I also have to try standing on one leg to improve balance. This has to be done with support. I read one of Norm’s earlier blogs saying the best way to do this is to stand in a doorway and hang on to the sides and having tried it I have to agree with him, it feels very safe doing it this way. He has also said I can walk in bare feet or shoes indoors only. This is proving quite difficult as my confidence dips without the boot on. My ankle also feels very stiff after long priods of sitting. He has also told me to apply regular heat to the back of my heel to improve blood flow to the area particularly whilst doing the excercises. I get the feeling that this is where the hard work starts i.e. the more you put in the more you get out, but if you put too much in it could spell disaster and you could end up at square one. I go back to the physio next Friday the 29th Oct. Will keep you posted with my progress. Happy healing.

Responses

I think everything you say sounds right, Andrew!

You have to get your leg used to moving and working, and surviving without the boot. But you are also entering the highest-risk period of your rehab, because you’re doing those things. Be gradual in your approach, and by all means Watch Your Step.

My fave protocol uses the verb “WEAN” when they talk about getting out of the boot — you’ve got to get used to barefoot and shoes, like an infant gets used to eating solid food. Gradually.

It’s also important to be gradual in introducing exercises and intensity, because we can’t rely on PROMPT discomfort or pain to stop us from overdoing. But if you were OK doing 5 of those things yesterday, you’ll probably be OK doing 6 or 7 of them today, and ditto with resistance or weight or force. If you jump from 0 straight to 10, you may well regret it later, even if it doesn’t hurt right away.

Good luck, and good healing!

Hi andy i am also 8 weeks post op going for my 1 PT this week . i am mostlly out of my boot and my toes point down a lot .are you toes in neutral or also down? I only use boot (no wedges )for 1.5 hrs a day . to get into boot heel down is a mission. when you said you have to stand on one leg ,is it the good one?

SouthAfrican, what a lot of people here have found helpful for getting your ankle-and-AT used to being in “heel down” neutral, is sleeping in the boot. After you’ve been in it for an hour, I assume that position starts feeling more normal, and less of a stretch? After 8 hours of snoozing, you may wake up to find that your leg has learned a lot. With luck, you won’t have to do it more than once or twice to do the trick.

Same thing applies to folks who are removing heel wedges from a boot one at a time: Try doing it at bed-time. Leg gets used to the position while you sleep, and THEN you add your WB in the morning. Doing them both at once is often a shock, or a pain — and usually a “stretch”! (The “stretch” is unavoidable if you’re doing casts instead of boots. Many of us who tried both strongly preferred boots, only partly because of this difference.)

Hope that works for you!

Hi South African, I am out of the boot now but had to wear it for six weeks continuosly, I never took it off for longer than about an hour at a time and mostly to wash my foot, I also still sleep in it and will continue to do so until I am confident I wont accidentally damage my AT during sleep. I started with five wedges and removed one each week. I then wore the boot for a further week without any wedges, my foot at this point was in the neutral position. I had no problems removing the wedges I always did it first thing in the morning. I found that with my foot and ankle nice and warm the stretch was barely noticeable. If you are experiencing pain at the back of your heel when trying to sleep I found that loosening off the straps while keeping the side airbags partially inflated helped a great deal. It allows your foot to move slightly but not enough to cause any damage to the tendon. I have been FWB from week 2 post op with no problems, this was always in the boot. From week 8 My PT told me I can walk without the boot indoors only in shoes or barefeet. If I were you I would try to wear the boot for longer periods to get your heel down. The standing on one leg is the bad one, it starts to fire up some muscles in the foot that haven’t been used for a while and seem reluctant to come out of retirement. Hope my comments assist you with your recovery, good luck for the future.

Thanx andy the difference between u and me is ,i slept with the boot on for 6 weeks but did not remove wedges . i had my big toe tenon ( still attached to my calf muscle )other side attached to my ankle bone (hole drilled ).the bone takes 6 weeks to heal and i had to keep my toes down in case the tenon comes loose from ankle. i have been sleeping without boot since 6 weeks. i will try sleeping with it now . i stretched (with elastic band in hot bath ) but i got neutral for a short while ,but it is back down again and very swollen to day

SA, don’t stop working to control the swelling.

And after 6 weeks toe down, it’s natural that your ankle would consider that angle “normal”, and that it would be a stretch to get to normal. This, too, shall pass! Just be gradual and incremental and patient with it and it should come around!

SA, the rear of my leg still feels tight when walking barefoot. However after my stretching exercises the PT gave me the leg loosens up for a while probably about an hour and then startens to tighten again. Dont know if this is normal maybe some of the other bloggers could help us out with this one, I will also discuss it with PT this Friday at my 2nd appt. I totally agree with Norm’s comment regarding swelling, try to keep your ankle above the level of your heart and if you can avoid sitting for long periods as this really causes the foot and leg to swell.

All the best…………Andy

I had my first Pt yesterday and my foot was very swollen and sore but is feeling better to day .I also slept with my boot on and must say how well i slept DEEP (safe feeling )Got my shoe built up 20mm to try and walk in boot and crutches HOW DOES ONE DO THAT !!i found it impossible. My PT said standing on two legs is only 50%WB
Has anyone have advise on skin soreness ,my whole body is sore from lying in bed (it feels like i am sleeping on sandpaper)

w0w i just discovered the boots air bags . i never used the air bags because i hardly used the boot . i would normally just use boot to bath , travel a to b . i inflated it for the first time to nite beautiful seport . i love this boot

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