Jul 28 2011
9 Weeks: A Trot Down the Stairs and Other Small Things
There’s not a lot to report during the last two weeks but I thought I would check in. A co-worker of mine just complimented on how well I’m walking today so I’ll take that as a small victory. The other bit of noteworthy progress I’ve had in the last few days was that I finally gained enough flexibility to take steps going down on single feet, rather than two-steppin’ it all the way down. This has been nice because I no longer have to offer people the chance to go around me when going down multiple flights of stairs at work (I generally prefer the stairs to the elevator when under 5 flights so when the shoes went back on I decided to say goodbye to the elevator). I can’t say I’m taking the steps without thought as I still really pay attention to what I’m doing, but two weeks ago I wouldn’t have had the flex to do it.
Flexability is where my focus continues - specifically dorsi ROM. My surgeon said she expected me to be ‘a little better than 90 degrees’ by my 12-week appointment, and I’m already there; however, progress beyond that is slow and I’m still not perfect with my walking gait. I’ve discovered that through focused stretching and exercising I can gain several degrees of ROM in a given PT or gym session which lasts throughout the day; however, my tendon has amnesia and ‘forgets’ 90% of it by the next day. I really don’t have too big of concerns about my calf strength, it seems to be returning quite easily, although it does fatigue much quicker on the stationary bike than the other leg.
I have minimal swelling after a day of good use, which quickly subsides when elevated. I also have one small area on my scar - at the heel - where my shoes (mostly dress shoes) irritate it a bit. Seems like the battle there remains a stalemate - not getting worse but always slighty red and sore. Hopefully I can solve that in the next few weeks.
I think this site needs a dorsiflexion progress widget that displays the status of a user’s ROM. This seems to be a challenging area for many of us - particularly those of us who went the surgery route. Obviously, it’s not good to rush the range of motion by stretching too aggressively, but it would be nice to monitor the progress of fellow ATR members and see the correlation between ROM ability and milestones such as a limpless walk, playing golf, taking the stairs, etc..
5 Responses to “9 Weeks: A Trot Down the Stairs and Other Small Things”
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Dorsiflexion is my challenge. I am getting around with a limp, trying to roll my foot into the gait with a pushoff, it takes a lot of concentration for me at this point. If I want speed, i have a tendency to hyper extend my foot out and thats a no no. I agree, i think progress after two shoes is a bit slower and less noticeable. Stay the course!
Polly, Jeff - although a bit ahead of you I still remember and empathiese with everything you describe. I didn’t think I was having any progress with dorsi flexion but now at almost 14 weeks can see that I have gain a lot back. My physio put some wedges under the inner sole of my runner and told me to concentrate on walking properly and I was not to remove any wedges until I could. At first I could only walk slowly but soon I was into full stride again without a limp. I took a wedge out and slowed down a bit but my pace returned. Last week I did a 4km walk in 45 min. Was a bit fatigued at the end and when it started to get a bit sore I slowed right down and shortened my stride. I am now weaning off the wedges, only wearing them when I am exercise walking and at the end of the day when things are a bit sore. Still icing and elevating when I need it too. It is sooooo….. nice to be able to walk at a good pace for some of the time at least.
I’m still not sure if wedges in shoes are a good idea or not. The protocols from my fave studies all(?) do not use them, though other Docs swear by them, and many patients seem to like them. Also, there are two abilities that have to be re-gained to walk properly in shoes (or barefoot): Dorsiflex ROM, and enough calf strength to “push off” from that flexed position. At least for me, the ROM was much quicker than the strength.
It seems logical that the necessary calf strength is about the same as the strength needed to do a 1-leg heel raise, but it’s actually significantly less. My stride has been perfect for a LONG time now (AFAICS). but my 1LHR is still short and difficult. One big difference is that a 1LHR is straight up with all your weight on it, while a stride is angled sharply forward, maybe 45 degrees. If 45 is right, that would make the stride ~30% easier, which “feels” about right to me. Even “silly walking” with a kind of 1LHR at the end of each stride seems much easier than just standing still and trying to go up full-height on one leg — and that makes NO sense, except that it’s brief, and there’s some momentum involved that might help a bit.
And BTW, there’s a “trick” that can let any of us/you walk downstairs normally in a boot, or in 2 shoes with no dorsi-ROM. I’ve described it a number of times here. If anybody’s interested, ask and I’ll probably notice and repeat it. Basically, you let the sole of your foot “roll” around the nose of the step. It takes a very sharp eye to notice that you’re not doing it completely normally, and you go just as fast as you would doing it normally. (You might have your head bowed a bit, since foot placement on the step is crucial!)
Regarding the wedges in shoes, I have to say that I am convinced they have been a good thing for me. My doctor recommended them but it was my physio who really came on strong and after her tendon revision course with one of the world’s leading physio’s, she was even more adamant. They allowed me to walk at a normal pace with a normal stride and without a limp. They protect the tendon from that extra bit of load on the push off and as you increase your ROM you can reduce them. My lifestyle turned a corner. I was able to walk for exercise and at the same time I was increasing the ROM of my foot. I don’t feel it has put me back in my rehab. I am sure other protocols work just as well and the experience of others will be just as valid. Whether they are a bad thing is the question and on that I can say not for me.
On a totally different topic, I am sitting here writing as I watch the sun rise over the Pacific Ocean after a big party last night. Why am I the only one up? My partner and I catered and cooked the thing so I couldn’t get much of a break until late in the evening. My foot was burning by then and it felt good to get horizontal last night. Tomorrow we have an Auto-gyro flight over the coast as a present. That will be the most exciting thing I have done in over 3 months.
Stuart — I am so glad to hear that your party was fabulous and that you are enjoying your well-deserved holiday! Please continue to have the very best time and do exciting things!
Thank you again for all your wonderful commentary here. I always learn so much about ATR recovery from your thoughts and experiences.