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.

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.

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.

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.

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.

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.