My leg doesn’t work right.

After telling myself I’d take the PWB process slow and steady, I ended up testing out some unassisted steps in my boot last night and it went better than I thought. I gave myself 5 minutes to shuffle side to side along behind our couch, holding on initially, and mainly focusing on shifting weight from one foot to the other.

That got me over some of the fear of putting weight on my healing side, I guess. I tried a few shuffle steps from there and ended up in the kitchen, then down the hallway to the bedroom, and then I quit while I was ahead.

This afternoon and evening I practiced some more and managed to prepare dinner without any crutches or iWalk…what a treat after so many days stumping around in the iWalk. The best part, though, was my son following me around saying “Look at that! Look at that!” and “You’re walking! That’s good!” Kind of an emotional moment, to be honest. It’s 2 months to the day since my injury and this is the first time I’ve walked anywhere near normally since then. It’s been hard to deal with not being able to be active with my son, so his delight at me moving around - even in a still-limited capacity - meant a lot.

It’s kind of fitting, really. I’m not sure how much of this he remembers, but about a year ago the roles were reversed and I was helping him with PT exercises. He was a little delayed in starting walking, so we did leg strength and coordination exercises every day at home for about 7 months. We used the same timer and checklists that I’ve been using for myself. And ultimately, we were after the same result - learning (or re-learning) to walk.

Still a long way to go, but it’s nice to have a bright spot, that’s for sure.

It’s hard to believe I had surgery seven weeks ago. And the injury itself happened two months ago!

My doctor erased my PWB timeline concerns by declaring I could go PWB as tolerated, and then on up to FWB when I feel ready, so that’s nice. I’d already tested out standing and bearing some weight in the boot; now I’ll make it official and see how I do. I was only in the office for 10 minutes or so. It’s such a change from my first visits when I’d get light-headed at the thought of going in there and getting evaluated, talking about surgery, getting stitches out, etc.

For boot aficionados or shoppers, the Breg boot (Genesis Walker), though a welcome change from the cast four weeks ago, doesn’t feel particularly well-suited to this injury or at least the PWB/FWB phase. I’m eyeing those VACOcasts with envy now. But hey, the Breg and I have come this far so I’ll give it a go. I added an orange SuperFeet insole that provides a better feel when I practice shifting weight around. Without it my foot moves around in there (the liner also slides against the outer shell), and that kind of movement doesn’t give me confidence as I try to re-learn this whole walking thing.

I thought the doc would be impressed with my range of motion but he rightly pointed out that moving my toes doesn’t count. It feels like I’m moving my foot a lot more than I actually am. With three weeks of PT between now and my next checkup, I should be able to show him some more progress.

My goal is to have everything looking good enough to get an all-clear for driving at week 10. Even though I know some folks have started earlier, I didn’t even ask about it today. I don’t think I’d want to try at the moment - the stiffness and weakness make me think I’m simply not ready. I’ll be happy working on my PWB-FWB work and going from there.

Onward we go! Here’s to PT twice a week, exercises at home, and with any luck a lonely iWalk gathering dust in the corner soon.

Today was PT appointment #1 and I liked the DPT who worked with me (and the practice overall). She measured ranges of motion on my good and bad ankle, showed me some basic ROM exercises similar to what I’ve been doing, and added in a contrast bath recommendation to help with swelling. 3 minutes hot water / 1 minute cold water repeated 5 times, twice a day. She did some really gentle stretching of my foot/ankle and then hooked me up to a TENS machine for the last 10 minutes. I can’t say I felt any different after the TENS thing. It was an interesting experience nonetheless.

(edited to add exercises)

Here are the specific exercises if anyone’s curious:

• Ankle Pumps - bend foot up and down at ankle - 2 minutes, 3 x daily
• Ankle Circles - move foot in circular direction - 2 minutes each direction, 3 x daily
• Calf Stretch with Towel - hook towel under foot and pull until you feel a stretch in calf - 30 seconds x 5 repetitions, 3 x daily (taking it easy on this one as I’m still wrapping my head around pulling on my foot, even gently)
• Straight Leg Raise - lying on back, raise leg with a straight knee, hold 3 seconds. 2 sets of 10, twice daily
• Hip Abduction - Sidelying - lying on side, raise top leg with knee straight and toes forward, hold 5 seconds. 2 sets of ten, twice daily

I forgot to note the ROM measurements but the therapist said my good calf is really stiff, and that a similar level of inflexibility could have played a role in the rupture on my bad leg. I’d thought about that as I looked back on my pre-injury fitness and it makes sense. I hadn’t spent as much time stretching as I used to back when I was running regularly. She’s going to make sure to emphasize stretching and strength work on my good side as well; I’d mentioned that one of my main goals is protecting my left leg and improving flexibility overall.

There’s some kind of disconnect between what my orthopedic surgeon wrote on the PT prescription regarding PWB, what he told me in the office last week, and how the PT folks are interpreting all of that. I’m going to proceed as planned, which is gradually getting used to PWB with the crutch for help. The therapist thought the instructions indicated starting PWB 2 weeks from now, at the 8 week post-surgery mark, and that doesn’t sound right to me. She’s going to call the doctor to verify. I also have another doctor’s appointment next week so I’ll run that all by him again. I don’t think that had a huge effect on the early PT schedule because all I’m doing out of the boot is ROM stuff anyway.

It’s funny - I’m kind of numb to getting mixed instructions from the doc and now the PT. I get the sense both are caught firmly between the old ways and the new with regard to this injury and the options for recovery. I’m glad I found this site and have been able to combine all of the information from multiple sources to come up with a general plan that feels comfortable.

All in all, I’m glad to get started on this next phase but there’s also a bit of a letdown feeling. There’s not much new to do at the moment - maybe a slight increase in the exercises - and scheduling 2-3 visits a week is quite a task until I can drive myself. I have to get my wife or my parents to drive me and watch my son, and that’s a tall order during the work week. I could only schedule 2 visits for next week…that might be the most I can do on a regular basis. Seems like most of the real work is done at home, anyway, so maybe that’s not the worst thing in the world. Now that I think about it, 3 visits a week doesn’t feel that necessary.

But hey, progress is progress! I’m happy that ROM is steadily getting better and there’s no pain to speak of. I think I’m just in one of those valleys you hit during the recovery. There’s still sooooo far to go.

I had a 5-week checkup today with no surprises (it’s actually day 34 but who’s counting?). That’s a relief given my fall last week and the fact that every little twinge made me think I’d messed something up. I’ve felt good but it was nice to see the doctor give my leg a once-over and say that everything looks like it should.

I’m cleared for neutral in the boot, I can slowly start PWB, and I’ll have my first PT appointment late next week. Also continuing the gentle ROM exercises with the boot off. Neutral isn’t too much of a stretch now (ha) but I’m going to leave my little heel wedge in for one more day so I can get used to the idea. The fall spooked me so I’m feeling extra careful these days.

Has anyone “interviewed” PT places before the initial session? I didn’t get much guidance from the doctor - he said all 3 that are in-network are good - but I want to be confident in the PT plan. I suppose I can always change providers if I don’t like how the first visit goes.

Aside from having the checkup to look forward to, this was a fairly boring week. I have random pangs and twinges in my calf and ankle. Nothing that causes alarm, really. The incision looks good - most of the scabby stuff is gone. The skin around the incision is sensitive, especially by the end of the day. Sometimes it feels angry and irritated, other times it’s almost numb. I’m assuming the nerves are still figuring out what the heck is going on down there.

Overall, I guess boring is good at this stage. At least next week it’ll be boring with a dash of PT!

Man, just as I was feeling good about keeping myself protected in the first 4 weeks…I go and fall on my injured foot (in the boot, thank goodness) last night.

It was the simplest, thing, too - just crutching in to the bathroom and my right crutch slipped out from under me on the tile floor. Before I could even think about what happened my right leg was out and catching the brunt of the near-fall. It hurt, but it was more of a burning sensation up and down the back of my heel and calf. I did my best to quickly prop myself up with the other crutch and stumble around a bit. I think I pressed the bad leg down twice reflexively. My leg flexed in the boot a bit - there’s a little give in the upper part of the liner - but I can’t imagine it moved very far.

It’s hard to separate the physical feeling from the initial fear. And there was a lot of fear. The pain and burning stopped as soon as I got weight off of my leg. In the end it felt more like a stretch than anything worse - no tearing or popping sensation. There’s no swelling and the incision looks fine. Basically, everything looks the same this morning as it did before the stumble. I have the same basic ROM but haven’t pushed that. I just strapped the boot on tight and will now keep my fingers crossed.

My guess is that my calf flexed/tensed for the first time in 5 weeks and most of what I felt was tightness related to that. I did have a few little twinges in the upper calf, like a light calf strain, but those went away within an hour or so.

Well, I made it 26 days before a fall. Here’s hoping that’s the last one! I’m not quite sure whether I’ll check in with my doctor this week. I have an appointment next week…without any other signs/symptoms I’m inclined to wait for the scheduled visit unless I start noticing swelling, bruising, etc.

This week will be a grind. My next appointment is on 4/13 so there’s nothing like that to look forward to. Now I’m back to my regular weekly schedule and tasks as a stay-at-home dad, only everything takes twice as long due to iWalking or crutching around.

Random thoughts:

• My boot is comfortable, and I enjoy the freedom of being able to take it off for showers or resting on the couch. I still have the discomfort of the casts in the back of my head so really anything is better than that 3 weeks of frustration. My only complaint is that the boot liner is loose and can irritate my incision. The assistant who fitted the boot mentioned that Breg used to include two socks and they don’t anymore. I checked out options online and decided to buy 6 pairs of tube socks (hello, ‘80s version of me) for the same price as one “official” Breg or Aircast sock. The tube socks work great - I put them on, fold them halfway down my calf, and the incision has some nice padding. And with 12 I don’t have to worry about washing them all the time.
• My incision gets irritated now and then but appears to be healing up well. There’s still a lot of scabby stuff hanging on, which is kind of gross. I clean the area each time I take my boot off and change out my sock - I sweat like a pig and it’s already warm here so I’m paranoid about keeping everything clean in there.
• I started using a cold therapy wrap on my ankle and foot a couple times a day and that’s reduced the swelling a bit. I think it also helped with ROM. My doctor didn’t give me any specific advice when he mentioned doing gentle ROM exercises (he also didn’t mention any icing) so I made up my own routine based on some protocols here. Basically, I do 15 side to side movements, 15 super-gentle up and down movements, 15 toe curls, and the spell-the-alphabet thing. Ice wrap before and after that, and I stop any movement if I feel any discomfort. Each day has been a tiny bit better, especially after I added the cold wrap component. I don’t notice any extra swelling or discomfort after these exercises so I figure I’m okay at this point.
• My secret hope is that being diligent with the early, gentle ROM stuff will somehow get me driving faster. Only time will tell!
• Seeing my foot move, even slightly, has been a nice morale boost. I finally stopped wanting to barf every time I saw my swollen foot and incision, and I’m starting to think I might want to play tennis again. (Immediately after the injury and surgery I never wanted to exercise or move quickly again.)
• Others have recently mentioned the fatigue at the 4-5 week mark and I have to agree. I’m not even fully 4 weeks past surgery and I feel like I’ve been extra tired at the end of the past 2-3 days. I guess it’s another one of the stages…I’ve been doing more work in the yard and around the house, but not enough to make me feel so wiped out (or so I thought).
• Still taking vitamin C and adding a protein shake as a mid-morning snack. Not sure if that helps, but why not? I’m trying to eat well and maybe even lose some weight over the next couple of months.

That’s about it. I’m in one of those doldrum periods - a ways to go until the next appointment and milestone. I’m hoping to get PWB clearance next week. Fingers crossed for some kind of progress indicator like that.