Post-Op Week 2-4, Physical Therapy and PWB

June 19, 2015

This post describes the period between my 2 week post-op visit on June 3 and my 4 week visit on June 17.  My visits are on Wednesdays, as was my surgery, so they correspond exactly with my week "anniversary" dates from the surgery.

I was told to begin partial weight bearing (PWB) but I still used the knee scooter almost all the time after coming home from my 2 week post-op on June 3, 2015.  That all changed when I went in for my first physical therapy (PT) session on June 9.  My orthopedic surgeon is part of a medical group in Reston, Virginia called Town Center Orthopaedic Associates.  It is an eight doctor group conveniently located in the same medical complex as our local hospital and ER, and in the same building as the outpatient surgery center where my surgery was done. Sharing the office suite with my orthopedic surgeon is the physical therapy facility, which is really nice because the therapists are part of the same practice, they have access to all the surgeon’s notes, and use protocols developed specifically by my surgeon.  Also, I was getting PT done here for my Achilles tear before I had the ATR, so I already knew and really liked my therapist, Chris Marino, DPT.

On June 9 I showed up for my PT evaluation by Chris. As I mentioned, we know each other.  He took a look at my wound, massaged it a bit with the boot off, and did some basic strength tests.  He looked at the scooter and told me that he never wanted to see it again, that I was done with it, and the we were going to start PWB immediately.  To that end, I put the boot back on, held on to the handlebars of the scooter, and walked across the room holding on to the scooter like a walker.  It felt funky in my right foot and hurt a little bit, but I was walking.  Chris explained that my protocol called for PWB and some basic flexibility during weeks 2-4.

So I started my PT - twice a week.  During this week 2 to week 4 I mainly did flexibility but also some strengthening of the unaffected part of my leg.  I used a BAPS board, picked up marbles with my toes, did seated knee lifts, had my surgery site pretty vigorously massaged. This is a pretty aggressive protocol but I really enjoyed the sessions.  One thing I was seriously warned about by my doctor was not to lift my right foot past 90 degrees of "neutral".  I was still in the boot with two heel lifts so my basic position was slightly toes down.  Man, did it hurt the first time Chris gently flexed forefoot up just a little bit to make my foot neutral at 90 degrees, but after a week I was doing it on my own.

Physical therapy is great.  I also started riding the exercise bike in the boot.  This was great because I had not been getting any exercise.  Chris cleared me to ride the bike as much as I wanted, so on Saturday I went to the gym and rode the bike trainer for half an hour.  I was still getting pain when I didn’t elevate my foot occasionally, so I found the recumbent bike trainer was much better since my feet are naturally elevated on that machine.

My PWB increased dramatically over these two weeks, and by week 3 post-op I was PWB to the extent that I was only using one crutch at home, and when walking with two crutches I was basically walking in the boot and just balancing and taking a little weight off with the crutche. This was progress over those first two weeks.  And yes, I stopped using the knee scooter completely.  I did not consciously increase the proportion of weight on my affected foot, but I found that I unintentionally used it more and more as the pain went away.

Also - I had been using some light aluminum underarm crutches that they gave me at the hospital, but they were very uncomfortable and I found them difficult to use. I went online to a place called "DME Direct" and I spent about USD 80.00 on a nice pair of forearm crutches - fully adjustable with spring tips.  What a difference these made!  No more pain in the armpits, and the spring tips do a great job of absorbing shock. I strongly recommend them - just like I strongly recommend the knee scooter for the period when you are non weight-bearing (NWB).