Monday, May 9, 2011

Latest Surgeon Appointment

On April 21, I had an appointment with my surgeon. That is 18 weeks and 2 days after the surgery. He said I'm getting some "power" in my foot. He also said the tendon they replaced is much bigger than the tendon they replaced it with as are the corresponding muscles so that I have to work harder to build the strength. He showed me how pushing down with my 4 small toes lifts my arch and suggested that I work on training myself to stand and walk like that (he said, "mind over matter") then laughed that he's never suggested that before to someone. He also said that the pain I feel in the very back of my heel is likely the screws and he recommends that I get them taken out. We tentatively said mid December (when my teaching is done for the term). Apparently, it's a simple surgery with no need for crutches after and a fast recovery. My next appointment with him is August 25 and we'll book the surgery then. I find the pain in the back of my heel seems worse when the weather is bad but I'm not sure if that's just a coincidence or not.

I also finally saw (in the x-ray) the tiny screw that was used to attach the Flexor Digitorum tendon on to my big toe area. I wasn't 100% sure that was there but I saw it very clearly in the x-ray. According to the surgeon, that one will never have to come out, it's embedded deep in the bone.

My rehab is going well. I am able (just as of this week) to lift myself up onto my toes. This is big for me as I was a little concerned I'd never be able to do it. According to the journal article I read about this surgery, in some cases, patients can not do this after the surgery. It still hurts to do it but it is now possible which is excellent. I feel my strength coming back for sure but it's almost been 5 months!

I swam in the All Out Swim Meet on April 16 and was able to complete all my races with pretty good times. The worst part was walking around the deck in birkenstocks (not running shoes) and getting onto the blocks safely. The timers at my lane would help me up and the starts were quick so there wasn't a lot of time to get wobbly! Swimming has been the best therapy for me through this entire recovery.

Wednesday, April 6, 2011

Rehab Revisited

I have now been almost 5 weeks of walking without the boot. It seems like a long time. I still have pain when I walk long distances and standing really gets uncomfortable but I also have a lot of improvement. Sometimes it is difficult to even tell that I have a limp when I walk. My biggest discomfort is in the very back of my heel (where one of the screw scars is). I hope it isn't a screw problem.

I changed rehab regimens. I was going to a physio therapist who iced my foot, did TENS and therapeutic ultrasound. I posted details earlier (in January). The physio didn't change since then and when I asked about my tight calf muscles I was told they didn't matter. I was told the low pain near my screw scar is achilles tendonitis. The therapy didn't feel right (just moving my foot in different directions) so I went for a second opinion.

I now see a chiropractor who is treating the whole bio-mechanics in my post-surgery self. It makes sense that I walk differently, I have muscle-wastage that needs working on in my calf and thigh. My chiropractor does ART (Active Release Therapy), acupuncture, electro-acupuncture, and is treating my calf muscles and even my tight hip flexors. I also do stretching, work with a theraband, do lunges on a half-ball and the floor, and balance on a half-ball.

I feel this new regimen is really making a difference. I think it's critical to treat my whole body now that my foot is physically different.

Friday, March 11, 2011

After 1 week of walking with no boot

My walking is improving every day. I can feel the strength coming back. It almost feels like I'm working out all the time muscle-wise!! I guess walking to the kitchen and back is a workout for my wasted leg muscles! I still have a limp and my balance is off but I'm working on standing on my right foot to improve my balance. I can't push up on my toes on my right foot at all. I couldn't before the surgery but this is something I should hopefully be able to do again eventually. I'll keep trying. My foot still swells quite a bit after walking but I'm supposed to keep going (push through the pain). My physiotherapist says I am coming down on the outside of my foot when I walk ... probably from years of over compensating for the arch collapse. I have to work on walking heel, toe and pushing off with my toes. I haven't done that for many years so it will take some work. Apparently, I have a look of consternation on my face when I'm walking ... Andrew and Hazel like to imitate me!!

Swimming is going really well. I do full flip turns now and push off with both feet. I am able to pretty much (almost) keep up with my pre-surgery lane-mates for most sets. I can even go ahead of some people on the kick sets and backstroke sets! And, I've been doing the breast-stroke kick!! Last night, I swam 3950 yards! That's the furthest I've swam in one workout since returning ... actually, since May 2010! I even improved my stroke somewhat after watching video of myself. Thank goodness for the Gators: coaches and swimmers ... and especially the Don Mills Bus Drivers who take me to swimming and back every time.

Tuesday, March 8, 2011

12 Weeks -- 84 Days

Hard to believe it is 12 weeks, 84 days since my surgery. Today I had my first standing shower since December 13. Well, that's not 100% true ... I had a quick post swim standing rinse shower with a cane after swimming on Saturday, March 5, but it wasn't a "real" shower. Today, I didn't even use the old-lady bench I've been using since December to help me get in to the tub. Progress!

I found my right Birkenstock (it was right there in the closet in plain view, Donny) so I've been wearing my Birks today. My physio therapist told me I should be trying to walk barefoot and without running shoes. It will help with the numbness on my heel.

That's it for now ... just a quick post to celebrate the 12 week mark.

Monday, March 7, 2011

Walking without the Boot!

On Friday, March 4, I saw the surgeon and he said I can start weight-bearing without the walking boot / aircast. So, when I got home, I put on my running shoes and tried ... using the cane to support me. It wasn't easy, my leg is weak feeling, and it hurts in my tendon area but I can do it and seem to be getting better at it already (2 days later). The best part is sleeping without the boot. I even think my ankle is less swollen and more loose when I wake up without the boot.

I must say, it was discouraging at first. I had regained so much mobility in my boot able to walk without the cane even up and down the stairs. I could even walk in the boot for a fair amount of time before it started to hurt. Without the boot, I feel I've taken several steps backward (pun not intended). I'm weak, wobbly, slow, and need the cane again. Not to mention the fact that it hurts pretty much the whole time I'm walking on it.

But I already see improvement since Friday! I can walk short distances in running shoes around the house without my cane already. After walking a while, it hurts and swells quite a bit. The swelling causes the inside incision to push against my running shoe which adds to the discomfort. I haven't put the boot on since Friday afternoon and I don't think I will. I want to just keep getting better at walking in my running shoe and I can't do that if I put the boot back on. So far, though, by 7 or 8 in the evening, my ankle hurts quite a bit and I'm pretty tired and just want bedtime to hurry up and arrive!

I still find walking barefoot really painful and, when I do, the numbness on the bottom of my heel feels really uncomfortable. The surgeon said he couldn't explain the numbness on the bottom of my heel but said it should eventually go away. I've already noticed the numb area getting smaller.

The surgeon also said I wouldn't be able to bend my 4 smaller toes independently of my big toe since the tendons are now merged just above the top part of my incision. But, I was able to bend my toes down while keeping my big toe up! He said that something "miraculous" must be going on!!

Here is a picture of both feet from the back at the 82 day post-op point. I have been walking today so it is swollen. Here is the inside of my right foot ... notice the still much skinnier right ankle area! There is an arch (not huge but it's there) ... compare with the pre-surgery version.

Tuesday, March 1, 2011

11 Weeks

Today, the first day of March, marks 11 weeks since the surgery. This morning, I accidentally walked in my boot with the 2 top straps undone ... well, not totally by accident. I sat down to do my exercises, started to undo my boot, and realized I forgot something. After undoing the top 2 straps (out of 3), I got up and walked. Wow ... what a difference if that boot isn't there to stop my leg from going forward. It was a bit of a shock but I didn't fall down, slowed myself down, and I kept going for a few steps. I actually started to get used to it! I can almost imagine walking without the boot. My physio therapist thinks the surgeon will say I can start transitioning to a shoe and brace after my appointment on Friday (March 4th).

I have been getting more and more exercises to do at physio therapy. I now do 3 sets of 4 things on the wobble board while sitting (up / down, left / right, circles clockwise and counterclockwise), bike for 20 minutes (level 9!), 30 leg presses, and now 20 calf raises on the leg press machine. Therefore, including the ultrasound, TENS, manipulation / stretching by the physio therapist, my physio appointment takes about 1.5 hours. I go 3x per week.

My exercises at home 3x per day are: back and forth 20x, left and right 20x, 10 circles each direction, write the alphabet, standing and stretching with right leg in front and behind (3x each for 15 seconds), pulling on my foot with a towel bent and straight (3x each for 15 seconds), with a theraband (15x slowly each): pull forward (toes to nose), push back (pointing my toe), in turn, out turn. If I do it straight, I can get done in 20-30 minutes but I usually need a bit of a break with foot rubbing in between some of the stuff (especially after the standing stretches ... they are the hardest and hurt the most).

Yesterday, I tried lying on my stomach on the floor. It sounds like that would be easy but just having the top of my foot flat on the floor provides a good stretch. It felt good so I tried a plank on my toes and I was able to do it! That felt good so I tried a downward dog flow ... it wasn't pretty but I was able to do it ... except for doing a proper roll-over-the-toes transition from upward dog to downward dog. I think I will add this new set to my daily exercises (probably just once per day).

I fashioned a boot cover out of an Appleton Rum nylon bag to protect my foot and boot from snow and slush when I go to physio or swimming. It is bright red so I look quite funny in it ... but it works!

Swimming is going well. I am able to do pretty much the whole workout and all the strokes now (except I breaststroke kick). I also sometimes stretch instead of doing all of the kick sets. I've started doing slow, deliberate flip turns (I'm mostly afraid of banging my foot on the side of the pool -- even though I've only ever done that once or twice before in my whole life)! I only push off with my left foot but have started placing my right foot on the side when I push off to get used to it being there instead of keeping in the air! After swimming, my foot is the least swollen that I ever see it and it feels much looser after, too. I appreciate my team-mates who pick me up and take me home because I can't drive yet. I promise to be the "bus driver" for several weeks in a row when I'm able to drive.

I am now out of my boot most of the time and only put it on to move around the house (ie, walk or stand) and sleep. I was told by the surgeon to wear it to bed and until recently I preferred to have it on while sleeping but lately I've been thinking I would prefer to sleep without it. Hopefully, he'll say I can do that after my appointment this Friday.

Today, I'm on my own and the sun is shining and it is not wet or slushy, so I took Woody for a very short walk. I was able to avoid all icy spots on the sidewalk and we had a nice 20 min walk together! He was very patient and didn't pull on his leash. So, I'm making progress ... and, best of all, I pretty much never feel down any more. I think the increased mobility and my ability to return to swimming have really made a difference in the way I feel emotionally.

Tuesday, February 22, 2011

Weight Bearing, Walking, Swimming

On Friday, February 11, 2011 I took my first steps (in my walking cast / boot thing)! I tried first thing in the morning but it hurt a lot so I waited until I was at physio therapy and started walking there ... still using my crutches for support. I was advised to go heel, toe as I walk with my boot on. I was also told I could start using just a cane the next day (Saturday, 12th) which I did! It went fast from there and now I can walk short distances without the cane and go for 20-30 min walks with the cane. It still hurts for the first few steps but then gets better and then eventually gets bad again. At the start, the most pain is the very bottom of my heel then that subsides and the pain that comes later is at the back of my heel. After consulting with my physio therapist, I've learned that this pain is actually in my achilles tendon right where it attaches to the heel bone. I have some tendonitis there which apparently is normal when one starts weight bearing. I have to keep doing my stretching, massage it, and ice it.

We spent the Family Day weekend in Florida visiting my parents and it was there that I really started walking well. We went for walks on the board walk, the beach, at the Daytona 500 raceway ... and sometimes for 30 minutes. I learned that I can go longer if I pump air into my cast. It seems to take some pressure of the achilles tendon.

I went swimming for the first time on Sunday, February 13 and the Gators were very good to me!! I used a pull buoy for most of the swim but did some one-leg kicking and dolphin kicking from the hips. I swam 2000 metres which was a good start. I also swam Tuesday, February 15 with the Gators. In Florida, I swam every day either treading water in the deep end with the kids or doing lengths with my new friends, Maureen, Beryl, and Hazel. Swimming is very good for my foot. The swelling goes down and it feels much less tight afterwards. The only pain I feel swimming is on the damaged nerve area where just having water flow past it feels sore. In Florida, I even walked barefoot on the bottom of the pool as normally as possible in the deeper water.

One down side to flying to Florida was that I had to inject Fragmin in my stomach before and after the flight each way to prevent blood clots. I was apprehensive but it wasn't difficult at all and didn't even hurt (except a slight stinging for a few minutes after). Only one of the four injection sites bruised.

But, we had a great time visiting with my parents and celebrating Family Day with them. It was an excellent trip recovery-wise because my ankle got lots of exercise in the water and on land. I can't wait for the snow to melt on the sidewalks so I can go for a walk outside in Toronto.