14 weeks; Making Progress in DF

Hi all,

There wasn’t much to post last week, so didn’t do my weekly update (which is mostly for my own benefit in marking progress!)  The slow progress is discouraging sometimes, but at least it’s a continuous forward crawl - no backwards movement.

I am now walking pretty easily during the day - when I focus on using the ball of my foot.  It’s easy to slump back into limping when I haven’t stretched the tendon after sitting or I’m just not thinking.   When I first get out of bed in the morning, my AT is tight and I need to stand and stretch a few moments before walking normally.  It warms up before I get to the door of my bedroom and I can walk fairly well.  Ditto after sitting for long periods.  I’ve found that walking more brings progress faster - even more than PT and biking.  I can do two legged calf raises, but am putting very little injured leg into the lift.

My DF is about +6 active, and +14 passive.  I still have to get it there with a lot of stretching.  Here’s pics of the improvement:

img_1401 img_1412

The atrophy looks bad - but it is MUCH better and calf muscle is coming back quickly.  It looked like a 100 year old leg last month. :)  This is a pic of the scar and swelling mid- afternoon after PT and biking:

img_1409

And here is my eversion/inverson:

img_1415 img_1414

For those who are struggling with ROM like I did.  I’m getting there - slowly but surely.  Last but not least, my straight leg DF is better but still WAY away from my good leg’s ability:

img_1404

And this is with a fairly good inclined walker shoe. Not so great, and it’s what’s causing my biggest problem with normal gait.  My AT is TIGHT - and really only feels loose after a good hour of biking and PT.  Once I cool down, I’m really not very flexible again, and have to purposely get it warmed up by walking and stretching.   Sooo…I’m not where many are at this stage (which drives my sick, competitive nature nuts :) ), but life is getting back to normal and I’m able to do everything I need to, albeit slowly.  I’m still unwilling (not unable) to get back on my road bike as I don’t want to chance a bad hop off before 16 weeks.  I’ll stick to stationary as I only have TWO MORE WEEKS for that magic number…!!  I know, ryanb and eastcoastrunner - I’m a wimp - but I’m just so close and my AT is so tight, that I feel like a hop onto my injured heel would re-rupture at this point.  I just don’t have the DF to compensate for any sudden load applied.

I still have significant adhesions and the swelling gets a little worse at the back in the evenings - but not much more than you see above.  I shopped for back to school, visited a friend in the hospital, and walked over a mile easily with 4 wild kids during a 6 hour outing in shoes the other day.  I had swelling - but nothing noticeable by others. I wore dress shoes to Church with no physical repercussions- and that made me happy.

So I’m thankful to be where I am - and learning patience about getting to where I want to be.  I can take care of my family again, drive the cars, and clean the house.  I can move quickly if needed, but can’t run yet.  I’m in really good shape despite the limitations and my calf gets stronger everyday!!  I can really feel it when I walk.  Sorry for such a boring update - but "life as usual" is what I’ve been craving for these last few months - and that part is back. :)  I’m feeling good about my progress, and seeing a light at the end of the tunnel - PTL.  Praying for those of you just beginning this journey and thanking God for the little things I can do that I used to take for granted. Blessings, Kim

12 Responses to “14 weeks; Making Progress in DF”

  1. Kimjax– you are so NOT a whimp! I am just about to get back on my road bike on Friday, and I am 1 whole month ahead of you (18wks/1day)! (also terrified to do it because of the afore-mentioned Masshole Drivers..!) I enjoy following your blog because we have some similar stuff going on, even though we had different types of surgery. I like how you work through things. Sounds like you are doing fantastic! Keep up the good work and positive attitude!

  2. Kim - I think you are too hard on yourself. You are doing just fine. Looking at your second pic it shows you DF to be good. It is what my physio calls zero. As your barefoot gets back from the wall you go into the positive. It will still continue to improve over the coming weeks and months. The calf muscles will also start improving as you walk more. Keep it up and keep posting as it is a great encouragement to those behind you.

  3. Keep it going! I wish I was at your point only at nearly week 6 :( I was wondering if and when I could road ride again and feel I could if I rode on the flat! But scared to at this point?!? I know I won’t be able to run for a while but riding should be my first point of getting back to fitness! Good luck!

  4. Thanks for the encouragement - I’m so glad to be “done” with the really hard stuff! I have great compassion for those of you still in the trenches of boot and cast - ugh.

    pauls - plenty of folks are riding early on - I’ve been riding my Lifecycle since week 4 (with the boot then) and am nearly back to where I was for pre-injury rainy day workouts. Hubby wants me to wait a few more weeks to get on the road bike where I might need to hop off or evade traffic. I’m itching to get back in the saddle as the stationary bike gets BORING at longer intervals! At least it gives me a way to work off my donut intake. :)

  5. eastcoastrunner - I’d be afraid to get on the road in a CAR with MA’s, haha - I might still be waiting to drive!

  6. Thats great progress!! Keep up the great work, your journey has been inspiring!

  7. kimjax,
    Good to see your DF is improving and that your calf muscles are coming back. My calf is not cooperating as much as I’d like it to but I will ultimately beat it into submission. LOL

    BTW ATR recovery is not a competitive sport so don’t worry about where you are at compared to others.

  8. Kim- you’re making great progress. I wouldn’t call you a wimp at all. While I have no doubt that riding a bike would be OK for you- I think you’ve properly identified the risks. It will be an unexpected stop where you land hard on your injured foot, or even a crash where you could do damage. By all means, don’t take those risks until you are fully comfortable doing so. There are risks and benefits to these types of activities- we all have to find our own balance, and decide when the time is right to take on new things.

    FWIW, I had the same tightness issues you describe. What helped me most was the stationary bike. An easy 15 to 30 minutes spinning worked wonders. So much so, that I parked one in my bedroom, and started each day on it (for about the first 6 months).

    Here’s an anecdote about risk- when I broke my neck, I was unable to ride for quite a few months. Finally, I got clearance from my doctor to ride an indoor trainer. The real issue was that I couldn’t turn my head to look around, and it was hard to steer the bike outside. I had spent quite a bit of time as the captain of a tandem bike. Being the guy that I am, I figured there really wasn’t any difference between riding a spin bike, and riding on the back of my tandem. I just had to sit there and spin the pedals- I’d let the person in front handle everything else. So, I reconfigured my tandem bike to fit me on the back, and recruited one of my racing friends to ride on the front. Seems like a good plan, right? It was so nice to get outside again. Then, near the end of our first ride… we got hit by a car (I was OK, my poor friend took a bit of beating though as I smashed into him).

  9. Bicycling is a big enough part of my life that I started riding in my boot, after both ATRs. For a while after I was “2 shoes”, I got back into the boot for biking, to address the concern you’re feeling. It’s not pretty, but it gets you out on the bike.

    Stuart, I wouldn’t encourage anybody to refer to dorsiflexing knee-over-toe (both touching the wall) as “zero”, since we usually apply that term to neutral or 90 degrees, and knee over toe is way more DF than none.

    KJ, we/you have discussed before how your surgery significantly shortened your AT, and I’d be pleasantly surprised if you regained a lot more DF than you’ve got now. Keep working at it, but you may always get by with a combination of what you’re doing now — warming up and stretching whenever you let it “gel” — and lifting your right heel (or both of them) a bit early when you stride (after you regain your calf-and-AT strength, of course). Turns out I’m getting by that way on my right side, and I’ve been happily playing volleyball and running and jumping and bicycling. . . on it.

    Just try to avoid collapsing/opening that joint right in front of your ankle, toward the inside to gain flexibility.

  10. So good to see the ever improving results now Kim, I am always impressed by the way you manage to overcome the various difficulties and challenges that this infliction provides us with…. and I know it’s come from perseverance to get those results so hats off to you Kim you really are inspirational :)

    Congratulations and happy healing :)

  11. Kimjax, looks like you’re doing great! Good for you for being smart in your recovery road. You aren’t a wimp! I agree with ryanb that you’ve wisely ID’d the road cycling. Keep up the good work.

  12. Hey Kimjax,
    You are way beyond me in recovery but only 2 weeks in time (does that make sense?) and I’m using you as my inspiration! The ROM you’ve demonstrated in these photos is great.
    I’m going to keep a photo record of my own to compare - the recovery is slow and gradual but it will be interesting to see how it compares week after week. ‘Life as usual’ is so important and something I’ve really taken for granted this summer.
    Go for it and good luck,
    Jaxx

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