Tuesday, November 5, 2013

Week 10 and 11 - Last Doctor Visit and More Physical Therapy

Week 10 (10/28)
I met with my surgeon for the last time today.  He was pleased with the scar and healing of my ankle.  I told him that there is some popping towards the front of my ankle with no pain.  After he examined it and asked more questions he determined that it is fluid in my ankle from swelling that is creating gas, which is released.  He said this is normal and I shouldn't be worried about.  He told me to come in if it causes pain, or if I can feel the tendon popping.  I don't have to wear the ankle brace anymore, unless I do a lot of walking or running on uneven surfaces.  I was also advised against any side to side motion of the ankle (playing soccer, basketball, football, etc.) until at least 6 months post surgery.  I think I will avoid playing physical sports until my ankle stop swelling when exercising.

Week 11 (11/4)
I thought today would be my last day of visiting the physical therapist.  They measured my flexibility and strength again today.  Both areas have improved since last time.  They also had me do more balancing exercise and flexing my ankle with a band.  They added a new exercise; standing on a balance trainer with one foot for at least 30 seconds.  It puts more stress on my ankle, but I can see how it will help improve my balance and strength.  My visit was quick and they want me to come back on the 15th of this month to work on running again.  I haven't been running since June of this year.  Hopefully it goes well.

Wednesday, October 23, 2013

Week 9 - Second Physical Therapy Visit

My visit to the physical therapist this week was more intense.  The difficulty of the exercises has increased.  I can see myself only doing them every other day.  I still have to flex my foot up and down, and side to side with an exercise band.  The tension in the band has increased so it takes more effort to move my ankle, which is good since it makes it work more.  An exercise they added uses a soccer ball.  I have to balance on my injured foot and move the ball around my body clockwise with the other foot.  After this, I do it again counter clockwise.  It takes a long time to do, so I can feel my ankle getting tired.  I have a take a break before I can finish the rest of the exercises.  The last two exercises are with what looks like a giant rubber band.  It wraps around both ankles and I take bend my knees, keep my toes pointed straight ahead and side step without letting the band pull my feet in.  This works the outer thigh muscles.  When I asked the physical therapist why these muscles need to be strengthened, he told me studies have been done that show stronger thigh muscles help keep the hips, knees, and ankles alined properly.  He said for any physical therapy involving these joints, they like to strengthen the surrounding muscles for increased stability.  The last exercise I do is with the band over the tops and bottoms of my feet.  I stand with my feet shoulder width apart and march in place without letting the band pull my feet in.  I can feel my ankle getting stronger and becoming more flexible.  My ankle doesn't hurt much when walking, and only really has pain when I wake up in the morning.  Even that pain isn't severe and doesn't last long.   I haven't tried jumping or walking for long distances yet.  I get to visit my surgeon next Tuesday for what should be my last follow up, and hopefully the end of wearing the ankle brace.

Tuesday, October 15, 2013

Week 8 - Home Physical Therapy

The physical therapy at home has been going well.  I did the first three days without any problems.  On the fourth day by ankle started to hurt around the incision site each time I took a step.  I let my ankle rest for the day and changed physical therapy to every other day.  I has been fine ever since.  I guess it just need some more time to adjust to being physical again.  I have started to use the elliptical each day too.  I am starting slow and only going 5-10 minutes each time.  It feels like it helps to keep my ankle from getting stiff.  I feel like I can walk better without the ankle brace.  I only wear it when I am out of the house.  My next appointment with the physical therapist will be next week.

Monday, October 7, 2013

Week 7 - Physical Therapy

The only pain I have experienced this last week came from shin splints. My left shin only hurts when walking and I can't stretch the muscle enough yet since my ankle is still too stiff.  Walking too fast or taking long strides aggravates the pain.   Hopefully the pain will go away as I complete the exercises given to me during physical therapy.  The physical therapy facilities at TOSH are excellent.  My appointment was this afternoon and I didn't have to wait long after filling out paper work. 

The physical therapist asked a few questions about my injury and how my pain has been since the surgery, and then we got right to work.  He started by taking measurements of flexibility and swelling in my left ankle and comparing them to my right ankle.  He also measured the amount of pressure my foot could exert in four different directions.  This information is used to evaluate my progress in the upcoming weeks and to give us a starting point.

The exercises that I learned today are to improve strength and balance.  The first few use a flat exercise band with a loop tied on one end for my foot.  The other end is held in my hand.  The band provides resistance as I move it up and down, or side to side.  It didn't cause any pain, but I could see that my foot was weak from the shaking it did after going through several reps.  The physical therapist also had me stand on one foot (the injured foot) and balance.  The first few times seemed difficult, but the muscle memory came back quick.  He then had me close my eyes and try to balance.  I was surprised how much more difficult this was, even with my good foot it was difficult. 

The other exercises use a tube shaped exercise band.  One end is attached to a fixed object, I will use a closed door at home, and the other end is held in both hands.  I am too hold both hands away from my body and write the alphabet in the air while standing on my left foot.  When this gets easier I can stand further away from the door to create more resistance in the band.  The exercises didn't create any pain in my ankle and they were not difficult to do.  I am do to do all these exercise for every day for the next two weeks at home.  I will return to the physical therapy office in two weeks for an evaluation.  By the end of today I could tell my ankle was swollen more than usual.  I was told to expect this as I exercise and use my ankle more.

Monday, September 30, 2013

Week 6 - 2nd Post-Op Visit

My foot and ankle has felt stronger since last week.  I usually walk around in the morning without the boot while I get ready for work.  I can tell my foot is very stiff from not being able to use it these last six weeks.  My visit to the doctors office was quick today (10/1).  He examined the scaring and my range of motion.  He said everything looked to be healing as it should.  My range of motion and strength in my foot is also normal.  It is expected to be weak and stiff after six weeks of immobilization.  We talked about exercising and physical therapy.  He told me to avoid quick or sharp angle movements to the ankle until at lease 3 months post surgery.  That means no playing sports like basketball or soccer, and to avoid uneven surfaces.  I can do low impact exercising like swimming, walking, the elliptical or a treadmill at slow speeds.  He told me to listen to my body and watch the swelling in my foot.  Some swelling at first will be normal due to not using the ankle.  If the swelling is excessive during or after exercise I am probably doing too much too soon.  Also, the tendons should not pop or snap when moving the ankle.

During my visit I was also given a soft ankle brace that can be worn inside a shoe.  I am to wear it every day until I see the doctor again in four weeks.  Even though walking is so much easier when both shoes have soles of equal thickness it feels awkward to walk in shoes.  My foot is not used to having arch support and being able to feel so much of the ground surface again.  The only painful part of walking is when my left foot is extended behind me.  I still walk with a slight limp.  That will improve as the tendons get stretched more after a few days of walking and stretching.  The doctor told me physical therapy will be mostly done at home.  I only have to visit a physical therapist once every two weeks for one month.  They will give me exercises to strengthen my tendons to do at home for the first two weeks, and then when I return for the second time they will give me more advanced strengthening exercises to do at home.  I'm glad I don't have to visit a physical therapist multiple times a week.  This will help to save on time away from work and home, as well as unnecessary co-pays to insurance companies.  I still have to schedule my first visit with the physical therapist.  That will most likely be next week.


 The ankle brace is thin and fits in most shoes.

It has a shoe lace up the middle and two Velcro straps that cross in the
front and wrap around the bottom, and then stick to the sides. 

  Most people can't tell anything is there.

Monday, September 23, 2013

Week 5

Not much of an update this time.  My ankle has been progressing well and I can't wait to get rid of the walking boot.  I probably shouldn't have tried walking with out the boot, but I did, and it felt great!  It was only a few steps to test it out.  I could tell it was very stiff and didn't want to move.  There was no pain or swelling either.  I try spend more time with the boot off.  It still feels awkward to walk with it on.  One more week until I see the doctor again and hopefully a time line for physical therapy and complete recovery can be given.

Tuesday, September 17, 2013

Week 4 - Improvement

The beginning of my first week back to work was difficult.  I didn't realize how much my body still needed to rest.  The first few days I found it difficult to stay awake in the afternoon.  I usually work four 10 hour days, and have almost every Friday off.  The days felt like they lasted forever.  I didn't have any problems with swelling or pain.  I stopped taking ibuprofen every day, and only ice my ankle at night.  The incision seems to be healing well.  The scabbing is coming off.  I feel like I can put weight on my foot and walk.  I haven't done that yet and will wait to see what my limitations will be when I visit the doctor again in two weeks.  I'm looking forward to not wearing the boot and limping every where I go.  I do have some loss of feeling towards the lower half of my scar.  It's just on the surface of the skin I can't feel anything.  I can feel the pressure when I press on it.  It may or may not come back.  I'm not too worried about that.

Monday, September 9, 2013

Ankle Time Line (updated for week 10/11)

I will update this post with pictures of my ankle.
Left ankle, day before surgery (8/19/13).
Left ankle, day before surgery (8/19/13).
Left ankle, day before surgery (8/19/13).

 
1 week after surgery (8/26/13).
 
2 weeks after surgery (9/3/13).


3 weeks after surgery (9/9/13).





 4 weeks after surgery (9/16/13).





 5 weeks after surgery (9/23/13).



 

  6 weeks after surgery (9/30/13).




7 weeks after surgery (10/7/2013). Feels more
swollen after physical therapy. 





 
8 weeks after surgery (10/14/2013). Swelling almost gone.





 Week 9, I took these pictures just after doing
the physical therapy exercises. (10/22/2013).






 Week 10/11 (11/5/2013).

Week 3 - Back to Work

This last week has been more enjoyable.  I didn't have to lay down all day and keep my foot elevated.  The swelling in my foot has reduced and doesn't occur as often.  A few days after seeing my doctor I started walking with out crutches.  The first time I tried it hurt my heel too much.  Now I can get around and carry things with me if I need to.  Today I went back to work.  Most of the time I work at a desk.  Depending on the projects I am working on I will spend some time in a lab.  Luckily I don't have to right now.  It's nice to be back to work and feeling productive with my day again.  I take the boot off a few times throughout the day and stretch my foot enough to hurt but damage the tendons.  I feel like it's heeling like it should and now I can't wait for my foot to be back to normal.

Tuesday, September 3, 2013

Week 2 - First Post-Op Visit

It has been two weeks since I had my ankle operated on, well two weeks and one day to be exact.  I have been able to get up and move around more since the first week.  The only problems I have had involve taking a bath.  I have to wrap my leg in plastic and keep it out of the water.  Getting in and out of the tub takes some time and I have to be careful not to slip and hit my foot or injure myself.  It's not really a problem. It's more of an inconvenience. The pain has been managed with ice and elevation and has been minimal.  It still swells and hurts any time I don't have it elevated. Today (9/3) was the first time it did not immediately swell once I got up and walked around to get ready for the day.  I can feel some improvement in controlling the swelling.  I have not used any pain killers since falling back on my foot last week.  Last Saturday I finally got outside for more than a few minutes.  It was my son's 7th birthday.  I told him I wouldn't miss it.  We had a good time with family and friends at a park.  It was nice to visit with them too.  I mostly enjoyed being outside.

Today, I had my first post-op visit.  My splint and bandaging were removed by an assistant nurse.  It felt awesome to finally be able to scratch areas of my leg covered by the splint.  She said the swelling and busing looked normal, and that there was no sign of infection.  She also said the scaring looked really good.

 
  Finally free from the splint.

 Some of the gauze stuck to my heel.

 
Close up of the new scar.
 
I could tell my left thigh had atrophied some these past two weeks.  I could see it more clearly in my left calf muscle once the splint was off. After the nurse removed the stitches a physicians assistant came in to check on the healing, pain management, and to explain the next steps in recovery.  He moved my foot up and down (dorsiflexion and plantar flexion).  He also moved my foot inward (ankle inversion) and said that I am not to invert it outward.  This is to prevent the ligaments around the tendons from being damaged and not healing properly.  It felt good to stretch my feet and leg muscles.  He said I will have a cam boot for the next four weeks, and to slowly start putting more weight on my left foot as tolerable.  He expects me to be walking in the cam boot without crutches in the next three days.  He didn't want me going back to work full time until next week.  I was hoping to be able to go back today.  One more week won't be too bad this time.  At least I will be able to move around more.  My next appointment is in four weeks.  Physical therapy will start after that visit.  I have been sleeping on the couch in the basement for the past two weeks.  I am looking forward to sleeping in my be tonight.

Left leg atrophy.  The muscle feels soft and the skin is stretchy.

 My new shoe for the next four weeks.

Wednesday, August 28, 2013

Fall Back

My foot was feeling great until Monday afternoon, about a week after surgery.  I was headed up the stairs to take a bath when I lost my balance and used my splinted, non-weight bearing, supposed to keep off and protect foot to catch my fall and place most of my weight on it.  Pain!!!!  Nothing but pure pain shot into my ankle and up my leg.  I think I even saw stars.  I don't know how I fell back, but it happened.  I stood on the stairs with both hands pressed against the walls on either side and quickly put all my weight on right foot and yelled in agony.  I was worried I damaged the repair or ripped the stitches out.  I didn't feel or hear any snapping or popping.  It had been a week since I used any of the Oxycontin pills.  I took as many as the prescription allowed and iced and elevated my foot.  It took an hour or so for the meds to kick in.  My foot hasn't felt the same since.  Before the fall it would hurt when it wasn't elevated.  Now the swelling and pain is more intense.  Hopefully it will get back to were it was before the fall.

Sunday, August 25, 2013

Week 1

The pain from the surgery really didn't start until Tuesday afternoon.  Up to that point I had been laying on the couch with my foot iced and elevated.  I felt like I needed to get up and move around some and felt well enough to try.  I spent some time standing, changing clothes, brushing my teeth and taking a shower.  By the time I was done I could feel my leg swell up and the pressure increasing around the incision area and underneath the splint.  I took a few pain killers and laid back down with my foot elevated and iced. 

The only other times I got up the first few days was to go to the bathroom and back.  Being up any longer created too much pain.  Since then, I've been able to manage the pain through ice and elevating my foot that I stopped taking the Oxycontin Tuesday night.  I am still taking the Ibuprofen as needed, and the baby aspirin until I see the doctor again, which is two weeks after the surgery.  As long as my foot is elevated and it doesn't bump anything, it feels fine.   The rest of the week has been spent sleeping, catching up on movies, and reading some books.  Netflix through the Roku have been great.  I don't have to get up or have some one change the DVD if I want to watch something else.  I can only watch TV/movies for so long.  I am ready to go back to work and do something productive for the day. 

Other discomfort I have is not being able to scratch inside of the splint.  There are some spots I can't get too.  Some time the stitches poke or tickle around my foot and I can't do anything about it.  The muscles on my lower leg will cramp up and ache.  If I could only take the splint off and stretch them some.  I think I can make it one more week.  I feel like I can't do much for myself yet.  I can get up and down the stairs, but I can't carry a glass of water with me.  I can't even stand long enough to microwave food.  If you decide to go through this surgery I would recommend having someone stay with you for the first few weeks.

Monday, August 19, 2013

Surgery Day, 8-19

5:30 AM
Wake up, shower, and get dressed.  The kids are already at grandma's house so we don't have to worry about waking them up and getting them ready too. The hospital is only 20 miles away, so we don't have to be up too early.  The pre-admission nurse told me to wear loose clothing that will fit over the bandages.  A t-shirt and basketball shorts it is.

6:30 AM
We arrived at TOSH (The Specialty Orthopedic Hospital) and checked in at the front desk.  After a few minutes of waiting, a nurse took me to a small room with a bed, bathroom, and monitoring devices.  I was impressed some of the technology the hospital used and how clean and professional everything is.  That may be an advantage to a specialized hospital rather than a full hospital.  The temperature reading device was a small hand-held type with a sensor in the end.  The nurse rolled it over the side of my face and the temperature was appeared on its screen.  I'll have to figure out what it was.

After recording all my vitals and receiving an IV, the anesthesiologist came in and explained the drugs he would be using.  He said it would be administered through the IV and the oxygen breathing mask.  Most other peroneal repairs I've read about a nerve block was placed behind the knee.  I'm okay with no extra needles.
Waiting to go into the OR with my new hat.

A few minutes later the surgeon came in to review the procedure, and recovery with my  wife and me.  He is an orthopedic surgeon that focuses on feet and ankles.  One of the reasons I selected him to be my doctor.  He said it would only take an hour, and they would remove the damaged sections of the tendon and sew it back together.  We discussed the possibility of cutting a ligament that helps to hold the peroneal tendons behind the ankle in order to make the repair.  This would mean a longer recovery time.  He also said he would only make an incision as big as he needed to.  He only wanted to cut a few millimeters beyond both ends of the damaged tendon.  Depending on what was done during the surgery will determine if I am put in a cast, splint, or a cam walking boot and the transition to other walking aids throughout recovery.

7:30 AM
The anesthesiologist came back to my room and took me to the OR. With out my contacts or glasses I can't  see any detail, just blurred masses of color.  I couldn't tell what anything looked like.  It was about 15-20ยบ F colder in the OR than the rest of the hospital.  I climbed onto the lowered operating bed while the nurse wrapped me in warm blankets.  I remember the oxygen mask going over my nose and mouth and being told to take some deep breaths.  The ceiling tiles began to swirl and blend together.  I was out.

8:30 AM
The surgeon found my wife in the waiting room and told her everything went well.  He only had to make an incision a few inches long.  Luckily, the tear was in a location that did not required the ligament to be cut and sewn back in place too. This is good news for me.  I don't want the recovery to be any longer than it has to be.  Some time before 9:00 am I regained consciousness.

9:00 AM
When I woke up, my eyes opened slowly.  I didn't feel tired, groggy, nauseated or have a sore throat.  Most importantly, I was not in any pain.  The constant sharp stabbing behind my ankle was finally gone!  Mostly all the strong meds are to blame, but I'll take it.  My sinuses were even clear.  I have had a minor cold since Saturday night.  Once a child gets a cold in our family it usually gets passed on to everyone at some point.  The nurse rolled me into the recovery room were my wife would soon join me.

My foot was wrapped in bandages with a splint.  Hopefully this means a quicker recovery time.  They reviewed my pain medications with my wife and said I could leave after they monitored me for about an hour while the anesthesia wore off.  They wanted to make sure there was no nausea and the pain was manageable.  The nurse asked if I needed any pain meds, but I declined.  I could feel my toes and some some pressure from the splint and bandages, but felt little to no pain.

10:00 AM
I will be non-weight bearing on my left foot for the next two weeks.  We live in a split level home, so too avoid using the stairs as much as possible I set up my living/sleeping area on the couch downstairs.  I have never used crutches before.  A physical therapist came by to teach me how to distribute my weight and the best ways to get up and down stairs.  He then hooked me up to a harness and had me practice walking up and a hall.  I also had to go up and down a step he brought with him.  I didn't think it would have been too hard to figure out.  I never realized the hands should take most of the weight on the grip and the armpit pads are really just to stabilize and keep the crutch in place while swinging your leg forward.

Waiting for the physical therapist and to go home.
  
10:30 AM
I'm on my way home.  A nurse helped me into a wheelchair while my wife went for the car.  My prescriptions were filled at the pharmacy there, so we didn't have to stop on the way home.  I was prescribed 800 mg of ibuprofen three times a day to reduce the swelling, baby aspirin once a day to reduce blood clots, and 5 mg oxycontin every three hours as needed for pain.

Home
I thought I would sleep more and be in constant pain.  I haven't slept yet and have only take one of the pain pills.  It is only 3:00 pm and I don't know how I'm going to make it through theses next two weeks of elevating my foot and being non-weight bearing.  I feel like I need to be up doing something around the house or playing with the kids.  I am grateful for my sick (head cold) and pregnant wife that is still willing to take care of me and the rest of the family.  She is amazing.