I done did it now--ankle/foot reconstruction

[Blitzzz (RIP)]

I did Physical Therapy for over 17 years the last 4 at FT Campbell, where there were many Ankle, Foot, Knees, and the occasional Hip surgeries. Hips are hard to regain full strength at full ranges, knees are easiest and Feet are tough to ever get back. All of this is because of the different amounts of use and number of movement directions.

Use because we walk/run all the time.
The hip joints have 4 planar motions (single joint, but Internal rotation,external rotation, flexion, and extension)
The knee also a single joint has only has 2 planar movements (flexion and extension)
THE FOOT ankle complex has many, many joints and planar movements. The Ankle alone has at least 6. (Plantar flexion, extension, eversion, inversion, internal and external rotations.
I don't know who did or how good your Physical Therapy was, But I am always more prone to exercising the specific muscles often overlooked. As you may know I am a great proponent of high rep low resisted exercises for neuro and muscular rehab.
Really strengthening the Muscles surrounding Ankle movement should better align the lower foot joints.

I would recommend highly a very specific working of those muscles before ever getting surgery. Simply because less time to recover a better fix. Surgery will require you much down time without the promise of a real fix, plus all surgical scaring will require rehab as well.
Imobilization will cause more muscle weakness. for any thing further PM me with a question and I may give you my phone number and we can talk Dave Boltz

[The Reaper]

Blue:

I have not experienced any serious ankle trauma lately, but I have previously recovered from a broken back and a broken pelvis, along with the usual assortment of smaller injuries.

You really need to do some serious introspection and look at where you are and where you want to be.

Understood that you like what you do, but if your lifestyle and occupation are going to be a never-ending, downward cycle of repetitive injuries, surgical reconstructions, recovery, and then reinjury, assuming that your long-term goal is to retire and be able to be somewhat mobile and to play with your loved ones and enjoy life relatively pain-free, rather than be pushed around in a wheel chair on heavy narcotics, you might have to reconsider what you are doing. You may be able to continue to contribute to your public service with a less active role in your community.

Our bodies were not designed, or intended to last forever while carrying heavy loads over long distances. Many of us can do so for a while, and then things start to wear out or break down. Some can be repaired or replaced, and some cannot. Thanks to modern medicine, we are probably experiencing life spans which are almost double what our forefathers who founded this nation did. That has the negative side effect of allowing all of those injuries to be doubled as well, and we pay the price of 60 years of hard living, rather than 30 or 40. IMHO, every surgical repair leaves you with less capability, to some degree, and makes subsequent repairs more difficult. As you get older, recovery times lengthen and results diminish. At some point, we have to get out of the game before it is too late. Not to put a damper on your holidays, but you might want to soon do some serious introspection and planning, in conjunction with your family and doctor.

Just my .02, YMMV. Wishing you the very best of luck and a speedy recovery.

TR

Pitfalls to watch out for:

You may know these already, but...you asked, so here are a couple off the top off my head...

1) Loss of flexibility due to non-use during recovery. At a minimum passive therapy should begin as soon as possible, even if it can only be tolerated in small amounts for short duration. Loss of flexibility will reduce your range of motion unilaterally, which will at least cause temporary difficulties with gait as a minimum, and can lead to injuries and permanent gait abnormalities over long term.

2) Contractures due to non-use and loss of flexibility. This can occur even in an "anatomical" position, but the worst is when it happens in an unnatural position. Because of lack of use the muscles and tendons lose some elasticity, which can cause range of motion to be limited or impeded, and can cause temporary or permanent deformity without proper treatment and therapy. You MUST begin stretching to maintain full range of motion. Maintaining full range of motion will help you return to normal gait post-therapy much faster, require you to go through less therapy, and thus should reduce your recovery time.

3) During recovery you need to be sure and put weight on the involved side as often as you can and place as much pressure as possible in a normal body alignment position whenever possible (ie: stand with your weight as equally distributed on each foot as much as you can tolerate, increasing until 50/50 is achieved) to keep your body from "learning" a poor posture that may cause problems down the road. "Favoring" one side for long periods of time can cause permanent damage at every weight bearing joint affected, including the spine. (Newton's Law...force one way equals force in the opposite) Hobbling over a gimp foot for months is a quick way to develop knee and/or hip problems on the same or even opposite side as well as cause lumbar & sacral problems from misalignment. Just remember if you are leaning or limping to take pressure from one place, it is simultaneously putting the additional pressure somewhere else...just be mindful where that extra pressure is being transferred to so you don't mess something else up even worse!

4) Muscle atrophy/hypertrophy. Atrophy of muscles in the involved limb due to non-use, hypertrophy in uninvolved limb due to overuse/compensation for weak limb. You know the negative effects of this...you run in circles and you look like a fiddler crab...don't do it. Same as above, do therapy, stretch, exercise, use the gimped leg as much as you can.

5) Also be careful on the crutches if you have to use them for a while. Ask for the ones that have cuffs around your wrists and not the long ones that support your weight at the axilla. People tend to "lean" on those and it can cause permanent damage to some nerves in the brachial plexus, this can lead to multiple long-term upper extremity neurological problems...bad stuff. It's better to have the cuff crutches anyway not only because they prevent this possibility, but because they are shorter and easier to haul in and out of vehicles.


I hope your surgery goes well and you make a full recovery. While you are with the orthos, get them to make you some good custom shoes!

Be safe,
Randy

[jatx]

Well, this is a little close to home, so I'll share some thoughts. I was recently discharged in connection with an ankle injury that failed to fully resolve after multiple surgeries.

First, a long-term ankle injury will likely lead to other problems that you'll have to work through as you heal. For me, two years of gait change added up to some hip and back issues that I didn't have before. None required surgery, but they prolonged recovery significantly and were hard to predict. If you have been limping for awhile, you have probably started to develop muscle imbalances in your lower and mid back, plus perhaps some tilting of your pelvis, all of which can lead to disc issues if you don't have them already. I didn't start to experience serious back pain until I started walking straight again.

Second, be sure you are getting worked on by a foot/ankle specialist, not just a run of the mill orthopod. My first surgeries were performed by generic orthopods from the Tricare system and it wasn't until I went to a true specialist that I received the procedure that actually helped me (and which would have been too complex for the other docs).

Third, ditch the crutches. They will just frustrate you and limit your mobility. Look into renting a turning leg caddy from your local medical supply shop. It's like riding a scooter that you kneel on and push with one foot.

Finally, understand what docs mean when they say "return to duty". Most have no idea the strain that operating with a heavy load over uneven terrain places on the body. This can cause them to elect for repairs that are not robust enough (I tore out a Brostrom repair within weeks of completing PT) and to underestimate the time required for recovery. Your recovery is as much about proprioception as it is about strength and flexibility, and the body's tolerance for poor balance plummets under a load. I.e., you may have full range of motion and strength back in four months, but if your balance isn't 100% you don't need to be under a load.

Sorry to hear about your injury - feel free to PM me anytime. I know that a lot of people recover from these things just fine, but mine was a three year odyssey of pain and frustration, so I know what it's like.

[jatx]

On my last go 'round, they sent me home with a leave-in nerve block for 72 hours. It looked sort of like a rubber donut full of drugs and I wore it around in a fannypack with the line taped down to my thigh really well. When it ran out, I simply went into the shower and pulled it out myself - a little messy, but fun in a grimly amusing sort of way. I was numb from the knee down for three days.

Anyway, it might be worth asking about. It kept the level of oral pain meds required down for the first few days when the pain is worst, which I appreciated after getting very shocky and ending up back in the ER previously.

[Gypsy]

Originally Posted by Blue

Well, surgery is set for Wednesday.
.......

He also gave me a handicapped placard since I'll be on my own for the most part. My 71 y/o mother is making fun of me.

Good luck, K!


LOL...nice.

[kachingchingpow]

Shattered right calcaneous here, due to a motorcycle accident right at 1 year ago. There's a metal plate and 9 screws holding my mess together. Sub-talar joint is shot. I could write a whole page of whining about what it feels like to put it on the floor first thing in the a.m. Exhausted my PT benefits last year, so I lost about 2 months of someone laying on of hands. Been working it out on my own, and I'm heading back in for some more ripping and gripping to get the ankle/foot back to an athletic minimum. Tons of scar tissue due to total necrosis of the wound and surgical site, with 5 months of wound care to address it. heel and ankle basically feels like it's wrapped with duct tape.

[kachingchingpow]

I've been told the same about the calcaneous. Long term prospects are kinda grim too. Oh well, I've never actually spoken to anyone who broadsided a car on a motorcycle at 50mph. Frankly, I'm lucky to be here, and so I just deal with what the Lord gave me, and try to get as much out of it as possible.

[alright4u]

Originally Posted by Blue

Well, surgery is set for Wednesday. I have stocked up on snacks and porn (ha!) and will be staying with friends since hubby is in Haiti. I plan on living on their sofa for awhile.

jatx, doc said no go on the caddy. He's seen issues with clots and doesn't recommend it unless someone is simply incapable of using crutches. Besides, I need to work my abs and arms while I'm doing nothing else .

He also gave me a handicapped placard since I'll be on my own for the most part. My 71 y/o mother is making fun of me.

Blitz has good INFO. I know a bit about ankle/foot problems as an AK 7.62 mm blew the fibula out and about 1/3 of the lower calf. I used to have a very tired foot after walking some as I walked like a damn duck. The troops could hear me approaching. I must have been a riot with that right foot slapping the ground like a duck.

Blitz is telling you straight. My ankle and foot have never got better- only worse. However, I had an ER surgeon in Tuy Hoa. You have a specialist. Best wishes.

[Blitzzz (RIP)]

Blue, if it's not too late, the crutches "rltipton" spoke of are called "Lofstrand" crutches.
Much better crutch for a relatively normal gait.
DLB

[kachingchingpow]

Then the damn thing went necrotic, and started going south. 5 months of wound care to get it closed up.