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.

Wednesday, February 9, 2011

My Human Foot

I want to try to express in words the evolution of feelings I've experienced about my foot.

For a few days after my surgery, in my mind and in my dreams, my foot was normal (well, as normal as my pre-surgery foot was!) I remember wondering when I would start dreaming "on crutches". It didn't take long. Soon (within days), in my dreams and imaginations, I was on crutches and soon after that (within about 3-4 weeks), I was unable to even imagine myself walking on my foot. In fact, if I closed my eyes and tried to imagine standing on the side of the pool (or on the starting blocks) and diving in, I couldn't. I couldn't even imagine starting to swim from within the pool.

I've been doing physio for almost 3 weeks now and soon I can start putting weight on my foot (2 days ... but who's counting?!) The process of physio and my three-times daily exercises has been gradually turning my foot back into a human foot! I can feel it. For about a week now I can imagine stepping on it! Sometimes when I have my sock off, I put my foot on the floor to feel the floor (well most of it ... heel is still numb). I also like to put my bare foot on the cold wall in my bedroom or the cold tile in the bathroom. Or when I'm lying on the couch I bend both knees and put both feet on the couch underneath my knees. Sometimes when I'm sitting down about to stand up, I almost accidentally put my right foot down! It's like my brain is getting ready to accept my foot as working again. This isn't something I've done consciously or even worked at doing. I've just noticed it taking place almost as if it's happening behind my back!!

Next step, standing (on both feet), walking, and swimming (not necessarily in that order) ... how I long to be in the pool!

Monday, February 7, 2011

Physio Update

I had physio therapy today and it was really good! I asked about weight-bearing and if I should be getting ready for that. He said that I can just start on Friday when I feel comfortable and in my house to start where it is safe. He also said that he expects I won't have a lot of difficulty because the swelling is minimal and the range of motion is good! This was great news for me because it is hard to tell when it is your own foot! I also got a red thera-band so I can start doing my exercises with some resistance. He also suggested I put a towel on the floor and a book on the towel and use my foot to move the towel toward me and to the inside. I have also been picking up marbles with my toes (it's pretty easy!). I am excited to have more exercises to do. I finished my physio with a bike ride: 15 minutes on level 5! Pretty exciting! Four days to putting my foot down!! Six days to getting into the pool!!!

Friday, February 4, 2011

52 days post-op: Picture comparison

I have been doing physio for 2 weeks and I'm 52 days post-op but still non-weight-bearing. I won't really know if things are working until I start weight-bearing.

I wanted to compare the progress because I feel like my foot is getting less straight and less arched. Here are two pictures from the back. In the first one I'm standing and in the second one I'm sitting with my feet on the ground (since I can't stand yet). Picture 1 from the day before the surgery. Picture 2 at 52 days post-op (7.5 weeks). There is still a lot of swelling it seems. Trying to stay positive ...

Monday, January 31, 2011

Keeping my Spirits Up

I had a fairly busy weekend and was able to see a number of people and had some excellent visits but Donny works on the weekends so I'm left on my own pretty much all day barking orders at the kids (which they don't much enjoy): can someone please walk the dog? could you please make me tea? please throw in the dark load of laundry and hang it up. please unload / load the dish washer. etc. As you can imagine no one jumps up and does it the first time they are asked. It gets frustrating!

When I imagined being non-weight bearing for 6 weeks (which has now become 8.5 weeks), I imagined doing stuff but on crutches. The one (obvious) thing I overlooked is the fact that crutches occupy both hands. You can't do much stuff without hands! I have figured out how to grip my crutches with my armpit and swing them around (one at a time) to move along which allows one hand to be free but this is a fairly dangerous practice! I few times I've knocked myself off balance while doing this. I've always recovered okay so far but I have nightmares about smashing my head into the granite counter top on my way down!

My physio is going well and doing exercises and icing 3x per day forces me to take breaks from working. I don't look forward to the exercises but always feel proud of myself when they are over because I really work hard at them. Today, my physiotherapist said he will get me on the bike next time! This is something I really look forward to.

In spite of all these positive things and the people who visit and the help I get from my wonderful family and the progress I'm making, I still have down times when I feel, quite honestly, sadness and despair. At first, I blamed the pain meds but those have been out of my system for a long time. I get mad at myself for feeling this way because everything is going so well and so many people are so much worse off than I am ... but the feeling just comes sometimes and I can't always push it away. And then I found this person's blog post called "The Mental Side of Recovering from Ankle Surgery" and that made me feel better about feeling down. She pretty much sums things up for me. I am (was) a very active person (swimming, yoga, walking a lot) and now I do pretty much nothing. I know it's cold out but I really miss being outside! I'm hoping when I can get back into the pool, I'll start even feeling better (count down: 13 days!)

Thursday, January 27, 2011

New Phase: Physio

I've been through a fair amount of physio in the past several years for my ankle, my shoulder and my back. It hurts but always feels good after and I've always felt good about going (enjoyed it, even). But this time I was really scared. I have a sense that my post-surgery ankle is much more fragile than my pre-surgery injured ankle. As a result, I was really worried about what would happen at physio. I was tense and it hurt and I had to do deep breathing to get past the pain (which I think now, in hind sight, was really more fear than pain).

Physio consists of the following steps: 1. ultrasound to reduce swelling and other stuff. The metal thing that rubs on my foot feels quite uncomfortable where my foot is still numb (it will take several weeks for the nerve to repair). 2. After ultrasound, I get fitted with TENS pads that connect to a machine that stimulates the foot to reduce pain, apparently. They put ice on top and then turn up the machine as far as I can tolerate (I’ve had this before on my ankle, shoulder, and back!). 3. Then the physio therapist massages the muscles (what’s left of them -- I've had muscle wastage!) in my lower leg and moves my foot forward, backward, left right, around holding each time and pushing much beyond where it wants to go. This hurts.

I have a series of exercises to do at home 3x per day.

That said, I really like the physio therapist and the place I'm going (thank you, Pearl, for recommending it) but after my first appointment, I felt down and discouraged. The next day, I did all my exercises but still felt down (almost inexplicably so). Today, I went to physio again and saw a huge improvement (mostly in my attitude!) but also in my range of motion and how much more easily I can manage the work they do on my foot. So, I'm feeling very positive about things right now and looking forward to each of my physio appointments!

Sunday, January 23, 2011

Progress

Now that I have the air cast, I feel more comfortable moving around. When it swells, I can take some of the air out of my cast to relieve the pressure. Yesterday, my sister, Sue, took me shopping. I bought stuff to make a delicious soup and a ready-made salad and a loaf of fresh bread. I came home and sat at the table and chopped vegetables and instructed Hazel on what to do with the ingredients. Together we made soup! It felt good to be cooking again!

I take my foot out of the cast 4-5 times per day and move my foot back and forth. Last night it was quite swollen after all my activity. Even this morning (Sunday), it was still swollen ... more so than Friday. I had another long soak in the bath and scrubbed my foot. It is interesting how much skin is peeling off (yuck).

I find I have to deflate / inflate the cast frequently to get the right amount of stability without discomfort. I'm guessing I'll get used to it soon and will get better at knowing how much is needed either way.

So, I think I'm making progress. I am looking forward to starting physio therapy next week!

Friday, January 21, 2011

Next Phase of Recovery -- Air Boot

Today, I had my blue cast removed and replaced with an air boot. The blue cast was cut off with this vibrating saw and then pried away with some fancy tools after which the white bandages were cut away.

I was instructed to move my foot back and forth but I still can't bear weight on it. I need to still use crutches for 3 more weeks but I start physio therapy as soon as possible. After 3 weeks, I can start to walk on it with the boot but will still use crutches. At the 6 week mark, I should be walking without crutches using the boot.

Here I look happy to have the boot on! But I was a bit disappointed that I'm still non-weight-bearing for 3 weeks. Even worse, I can't swim for 3 weeks. I am happy to have the boot, though, because I can take it off. I have to sleep in it so that will take getting used to. It is heavier than my blue cast and I am having trouble getting comfortable in my old positions so will have to figure out new ways to relax.

I can take it off to have a bath and already have!! Here are a few pictures of my foot before the bath. This one compares my two feet/legs. Here is the inside of foot. The steri strips will fall off in a few days. Here is the outside of my foot and the bottom of both feet.

It's hard to tell the difference in these "after the bath" pictures, but it is definitely cleaner and a lot of dry skin has been removed: The outside of my foot. Check out the skinny calf!! The inside of the foot. My feet together (Woody waits and watches). Finally, the bottom of my feet.

Thursday, January 13, 2011

Plateau ... or Progress?

It has been a long time since I've posted. Mostly because I don't feel like I have much "new" to report. In a way I feel kind of stuck at this level of recovery: cast on foot, energy in the morning, work at my computer lying on my back for as long as I can during the day, some outing most days (coffee, lunch, visit to the in-law's, etc.), tired in the evening, sore foot in the evening (mostly burning all down the outside of it), sleep, repeat ....

But then I thought about it and I think I may be making progress. The tops of my baby and next-to-baby toes are getting more feeling in them and I can sleep in 3 positions now (instead of just 2). I can move my foot around a bit in my cast (I'm probably not supposed to but I kind of like moving it). I'm getting pretty good at crutching and I even figured out how to get a cup of coffee (any liquid really) from the kitchen to the living room without spilling it: pick up cup, move cup as far along counter as I can reach, put down cup, crutch, pick up cup, repeat [at one point I have to move it from counter to coffee table but if I position myself in between the 2, it's doable!] Basically, I can do a lot more on my own.

I only have 8 sleeps until I see the surgeon next and maybe I'll get the cast off (fingers crossed ... hey, I can even cross my toes!!)