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.

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.

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.

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.