5 Months 19 Days Post Injury - Rehab Question

It’s been a while since I’ve posted… sorry, but my life is rediculously hectic!
Anyway, I was able to get PhysRehab for 3 or 4 weeks after getting out of my boot… I made great progress and everybody was impressed. I told my Dr. I wanted to use the protocol mentioned here and he really didn’t want to do it, BUT we compromised on a hybrid of the two sorta… It worked beautifully and all went well.

Then my life got busy… I haven’t been to therapy in 2 months probably… simply no time to do so.

My calf is strengthening every day just from my running around…

But my AT seems VERY tight… and my ankle around my injury location is rather “solid” when I squeeze it…

Is this normal? Every now and then I lean my knee forward a little and try to stretch it… I’ve been doing this for weeks now and it’s still very tight.

What can I be doing on my own to advance my therapy and get this thing back to “normal” (or as close to normal as one might expect)? What kind of stretching and exercise should I be doing at home?

Thanks

3 Responses to “5 Months 19 Days Post Injury - Rehab Question”

  1. Icky, it’s relatively rare for any of us to lose a lot of DF ROM through our treatment, and many of those people have a surgeon who shortened their AT on purpose — like mine from my first AT. Having it heal short after non-op rehab is possible, but it could be fixable, either with more stretching or with more aggressive inflammation control.

    First, measure your lost ROM. The standard test is to face a wall, plant your uninjured foot on the floor aiming straight at the wall, and push your knee into the wall. If you hit it, plant your foot farther back. “Rinse and repeat” until you can just barely touch your knee to the wall, and measure or mark or memorize the distance from your toe to the wall (or baseboard). Then try your ATR leg, and see how much closer to the wall your toe has to be.

    That’ll tell you the difference. Ideally you’ll be able to make up the difference, but quite a few of us (mostly post-op) could not, and I for one never had a hint of a problem from the decreased ROM, including lots of sporting activity, so don’t obsess.

    Early in rehab, patients concentrate on active DF (using internal leg muscles), then gentle passive DF, often with a towel in both hands, passing under the ball of the foot. At almost 6 months post-non-op, you should be able to stretch using your body weight, like the way you measured your DF, or like the way people (foolishly!) “stretch out” their AT before playing sports. (The recent studies all show that those stretches make you temporarily WEAKER and less capable in your games! And also NO less prone to injuries like ATRs!) Another variation, combined with a calf exercise, is to put the fronts of your feet/foot on a low box or a bottom step, and do LONG heel raises, dropping down as far as you can. Again, that would be very scary at 8 or 10 weeks, but it should be pretty safe at 22-ish.

    Here’s another idea that I think is worth a try: Even though you had very little swelling during your recovery, it’s conceivable that you’re losing some ROM from inflammation, maybe connected with that tightness and “solid” feeling when you squeeze it. I’d try doing the whole RICE thing, maybe for 24 hours: For one (”handy”) day, take it easy, elevate as much as you can, ice your ankle, and pop an Ibuprofen or two — and measure your ROM again. If it’s better, then the difference is joint stiffness from inflammation. I’m guessing that it will fade over the next month or two on its own, but you could also try popping a baby Aspirin 1/day, and seeing if that makes a difference. (My Cardiologist thinks everybody should, and so does Dr. Oz.)

    Good Luck, keep healing, and keep posting!

  2. norm has some good suggestions. I bailed on PT just before I hit 6 weeks due to travel, and have been handling the rehab on my own. here’s what has worked best for me (I think):

    1. walking, a lot of it. one week walking around San Francisco did more than those 6 weeks of PT.

    2. basic “wall stretch”, where you put one foot in back and one in front and stretch the back calf and achilles. the key for this one (which my PT pointed out) is (a) you should point your back foot in slightly, which ensures a more even stretch, and (b) you should do the stretch straight-knee’d and with your knee bent, to stretch both the gastroc and the soleus.

    3. heel raises, lots of ‘em (I do sets of 72 on two-legs and 36 on one leg, even if I have to lean on a kitchen counter for the bad leg to finish off the 36).

    4. the stair stretch norm suggested - stand on your tip-toes on a step, support yourself on the bannister or somehow else, and let you feet “hang” down as far as is comfortable.

    5. self-massage of the achilles and ankle. as gross as it sounds (and feels), I can actually feel myself pushing up the fluid that has built up from the swelling. eeeeew.

    my ortho said that full ROM could take up to a year, you just have to stick with it : )

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