Things I wish I’d known pre and post op

• First and foremost – This thing! http://iwalk-free.com/crutch-testimonials/ Only $149 and your insurance may cover it anyway?? Shut up and take my money!! If there was one thing I could choose to redo about my recovery, this is it. I would have had this, and would have saved myself scary moments on the stairs and transitioning from wet parking lots to slick floors. I did a lot of hopping because I hated the crutches so much. Had a lot of close calls when I was supposed to be completely non weight bearing, where I almost landed on my Boot Foot. The shoulder pain from the crutches. Oh God, the shoulder pain. Sometimes it would keep me up at night and was definitely worse, at times, than the post op pain. If I ever find myself non weight bearing again, I will have this.
• A frozen bottle of water will be your best friend for the first few weeks of full weight bearing. The bottom of your heel will feel painful and even crunchy your first few weeks of full weight bearing. You will think to yourself, “What the hell have I done? I had surgery to get rid of heel pain!” Thing is, it’s a totally normal response of the fascia to transitioning back to full weight bearing. Roll the painful areas on the bottom of your foot on that frozen tube of bliss for as long and as forcefully as you can stand to. Don’t stop til the painful areas are numbed. Repeat as often as necessary.
• You will need a backless shoe for around the house for awhile. Some recommend Crocs; I personally believe those holes in Crocs are where your  dignity escapes. I had a pair of Merrell clogs that were a godsend, and bonus – I’m not embarrassed to wear them out in public now, so $80 well spent.
• As for the long term outlook for your shoe collection – don’t make any hasty decisions. Seriously. Give it a year. Shoes that bother your incision area at 15 weeks out may not bother the area at 6 months out, or 11 months out. I hastily re-homed a pair of Merrell low cut hikers, and I’m regretting it, because other shoes I thought I’d never be able to wear again, feel fine now.
• Physical Therapy is at least 50% of the equation for recovery. Don’t skip it! Even if you don’t go 3x/week, a good physio will keep you progressing through range of motion and strengthening. Those were two very distinct phases in my recovery – both equally important. You won’t get to strengthening until you get more r.o.m. and you won’t get back to normal gait and activities without strengthening.
• Exactly a year ago today, I had my pre-op xrays and scheduled my surgery. I can’t believe a year went by so quickly. If you’re worried about the recovery time, read that previous sentence again. Recovery time truly is just a blip in the grand scheme, though when you’re in the middle of it, it feels like forever.

Life isn’t perfect

I’m still sore at the end of some days. That is what happens when you go from PT 3 days a week to back to your part desk jockey/part climbing/jumping/stepping/carrying/unpredictable movements job. I don’t stretch nearly as much as I should, and I can really tell when I’ve been neglectful in that area. 

I think, I have found that the key is, the more active I am today, the more normal I will feel tomorrow. It’s a tough concept for an instant-gratification kinda girl like me to wrap her mind around. When the alarm goes off at 5:30am for my pre-work walk, the first thing I want to do is hit snooze until I don’t have enough time to get a walk in. That 30 minutes of sleep costs me dearly in terms of flexibility and pain, though. 

If I want to progress to my former athletic self, however, it’s a concept I need to get behind asap. 

5 months out milestone

I just noticed this in the past couple of days. I’m not stiffening up as much or requiring a stretch just to walk without limping. Golfed 9 holes yesterday in shoes I couldn’t stand to wear last season. Came home from that feeling flexible and no residual pain. 

This surgery was a game-changer for me, in every sense of the word. 

Released from PT and ready to get on with life!

18 weeks + 5 days post haglund’s deformity excision and achilles debridement and repair, I had my last PT session. I won’t say I’m back to normal, but I’m at least 90% back, and I’ll take that.

Where I started 10 weeks ago (8 weeks post op):

• 1.3-1.5mph on treadmill, very painful and uneven gait
• smallest balance board for r.o.m., very painful and slow to get my 400 reps in
• outside of PT, walks of about 1 mile were slow and painful, and caused pain and some swelling for the rest of the day
• lots of pain to bottom of heel

About 4 weeks into PT (12 weeks post op):

• 2.8mph on treadmill, I could go faster but was still getting zinged along right and left bottom of my heel, scar tissue that eventually broke up with massage and r.o.m.
• Squat press 130lbs/50 reps (both feet), up on toes for 5 count, dorsiflex for 5 count
• graduated to tall balance board! 400 reps pf/df, inversion/eversion
• BAPs board on setting 3, 100 reps clockwise/counterclockwise
• Balance on cushion on op foot – could only manage a few seconds
• Walking lunges, 10 laps. Very much illustrated the imbalance between non op side and op side
• Sumo squat with 25lb kettlebell x 50, up on toes at end of each rep for 5 count

At this point I would still leave PT very sore, usually limping a little. Massage progressed from the area feeling bony, to a distinct crunching in massage area, to feeling a freed-up tendon moving during massage. Heel still sensitive to many shoes. Walks are now 2-3 miles, limping and sore the 2nd half. Always feels better to be moving, though, and feels great the next morning.

Week 5 of pt (week 14 post op) – managed a couple of heel raises on op foot! Big victory!

Week 7 of pt (week 16 post op) – back to work with no restrictions

After 10+ weeks of pt:

• walking easily 3.3-3.5mph on treadmill, pretty quick for my stumpy legs
• walking outside 3.4 miles, uneven ground not a problem. Dog is happy!
• balance board? We don’t need no stinking balance board anymore. BAPs at setting 5 for all r.o.m.
• heel raises in 10-20-30 sequence x3 sets(10 – hold for 5 count, 20 – hold for 1 count, 30 – quick pulse up/down) – difficult and most painful part of pt
• balance on cushion on op foot – getting up there! About 30-45 seconds
• squat press 90lbs x50 reps isolating op foot/leg. Up on toe 5 count/dorsiflex 5 count
• kettlebell sumo squats x50, up on toe at end of each rep for 5 count
• walking lunges x10 laps, up on toe on step through, now holding a 10lb kettlebell in each hand.
• ladder hops x10 laps, hop on outside of each rung with foot on same side
• finish off with 5 minutes on this thing:   http://www.fitter1.com/Catalog/Items/PF2.aspx#   (SO much fun.)

A little more swelling around the medial area of my ankle on op foot at the end of a long day, but I am on my feet more at work and doing a lot of movements with the foot repetitively that are pretty stressful. Also, that ankle has been and will always be a bit of a problem child. Walking – whatever I want. Running… I have jogged a few steps, but it’s not a priority for me. I am reasonably certain my poor form and rear foot strike while doing Couch to 5k program was part of what got me into this situation, along with my goofy foot anatomy – so let’s just say I’m in no hurry to run. I will still be sore after a long day. A long day on my feet still seems to be better than a long day off my feet. Definitely stiff after a car ride or sitting at my desk for too long. I notice the AT itself is sometimes a little sore at insertion, and up a little higher. I could probably avoid a good bit of this with a better calf and AT stretching regimen. Or, a calf/AT stretching regimen. Which is something I’m working on.

All in all, I am still in less pain than I’ve been in for 2.5 years, so it’s hard for me to assess whether or not what I’m dealing with now is “pain”. My theory is, if I have to think that much about it, it’s probably not. 🙂

Would I do the surgery again? In a heartbeat. I’m kicking myself for having waited and suffered for so long.

 

14 weeks out, a big milestone!

I did a heel raise yesterday in PT! Actually, I did a couple 

We had been working on it by having me go up on both toes, then taking the strong foot off the ground and holding the raise with the op foot and controlling the descent. I was able, yesterday, to get the heel off the ground by itself. Now, compared to the strong side it was a pretty pitiful heel raise, but it was off the ground at least a couple inches with no help from the other side.

I don’t know how much longer I’ll be in PT. I know I am going next week, and he talked about addressing some of the awkward landings I will likely encounter functionally when I get back to work. That is why I trust this guy so much. He takes into account what you’ll need to actually do functionally day to day, and step by step he incorporates stuff to strengthen and prepare you for just that.

The area that I was feeling the “zings” on both sides? The PT massaged them and it definitely felt better and freer for me after that, even though the massage alternately burned and stung. He said the tissue felt like bone, and he was huffing and puffing after doing the massage. It is all soft tissue area, so “feels like bone” was kind of ominous to hear. How arthritic is this ankle going to be? I have had a couple of bad sprains to that ankle, one that healed badly a long time ago, and another recently, that I was smart and did PT immediately after. I massaged the areas myself the next couple of nights before bed. I felt distinct crunching under my fingers in small (fingertip size) areas of the massage. I couldn’t locate the crunch the next time I massaged, and my ankle feels freer than it has in months. My PT said it was quite possibly old adhesions from prior sprains, plus the period of immobility in the boot. It’s not crunching anymore when I massage it, so it must have busted something loose!

 

In 5 days I go back to the OS for xrays and followup, and I’m hoping to hear the magic words – back to work!

Finishing up week 5 of PT

We subtracted the kettlebell-up-on-toes walk from the program due to the sharp pains I am having on the outside of my heel, when going up/pushing off on my toe.To sub in for that, I am doing heel raises. Can’t initiate one with the op foot yet, but what I do is go up on both toes, then take my weight off  I can get a fraction of an inch off the ground on the op foot by itself. It’s a start. 

I have been massaging the area on both sides where I’ve had those zings of pain – the ones on both sides directly below my ankle bone on both sides, where the bottom of the foot meets the side. It seems to start on the bottom and radiate up. If I keep going, it eventually numbs out and remains there, only dull. The PT massaged the one on the lateral area pretty thoroughly the other day. I have been massaging it myself and noticed that it feels a little … crunchy? Snappy? Clicky? … in one certain spot where the pain seems to originate. So I will ask him tomorrow if he noticed that when he was massaging. Makes me wonder if it’s remnants of bursae that need to break up. Definitely feels better and freer today after massaging last night. 

I don’t know how much longer I’ll be in PT. He hasn’t told me we are wrapping up in x number of weeks. I have an ortho followup in a week, which will be 14 weeks and 1 day post op. I am pretty confident I’ll be released back to work full duty – I’d better be, because I put myself on the schedule covering open shifts!

 

That familiar Zing…

… It reared its ugly head again. Outside of foot on the heel, directly below my ankle, starting from the bottom of my foot and shooting up. I have been trying to get 10,000 steps per day in and I’m cleared to do anything I want except jumping/plyo. I was walking the dog on the same flat, paved park path we’ve been using and all of a sudden… Zing. 

I limped for a good 1/4 mile after that then the spot sort of numbed out. I finished my 3ish mile walk, went about my day, and when I got to a place where I was going to be sitting awhile, iced my foot. It feels ok now so I guess it’s just more scar tissue breaking up. 

94 days post op, end of week 4 physical therapy

This has been a good week of building strength and endurance. The dog is happy to report we’re going for lots of walks. New things this week:

• my physical therapist massaged the incision and tendon, and showed me how to have my husband do it. It was a little uncomfortable, but felt great and flexible afterward.
• I realized I’m going to be a much pickier shoe ho. I’ve already gotten rid of a beloved pair of Merrell low hikers and my Brooks runners, and a few other randoms I frankly never wore, because they rub my heel the wrong way now. This is a first: I tried 3 pairs of shoes the other day, and realized none of them would work with my incision. Maybe it’ll get easier after it’s desensitized, but for now I’m more than a little bummed.
• 3mph!! on the treadmill. That’s a moderately fast walk for my short little stumps.
• I put myself on a 90 day challenge of sorts, hoping that I forget after 90 days that said challenge ever existed and it just becomes my life. Part of that is 10,000 steps a day. I’ve been getting that most days, pretty easily. I love comparing pre op and post op after a 10,000 step day. What a difference. After a 10k day pre op, I would be out of commission for anything but painful waddling for the next several days. Now, I still have a stiff first several steps, but once I get moving it feels great.
• Day 107 post op I have an ortho followup. My physical therapist led me to believe I’ll be released back to full duty after that. I’m ready. The only movement I should avoid at this point, I have been told, are plyometric jumping types of moves. Everything else is GO!

I guess it’s time to get used to waking up for work again…

PT Week 4 – focus on strengthening

What a difference this week. Most of the pain on movement is gone. If there is any discomfort now, I’d call it stiffness. Feels like I need a good calf/achilles stretch (but not sure how much of that I’m allowed to do, so I just stretch it out by walking). Also feeling a faint occasional sensation of adhesion at the incision site. Feels like someone left a strip of double sided tape inside there. I watched YouTube videos demonstrating how to massage that area, but they made me cringe. I should note I’m not a squeamish person at all. The massage technique was just that rough. 

The week 4 routine is geared toward building strength.

• Treadmill at speed and time tolerated with emphasis on good heel to toe gait. Today’s new speed record – 2:8mph. Almost normal! (I’m short)

• Squat press 130lbs with balls of feet/toes – sets of 10, at least 50 – at extension weighted plantarflexion for 5 count then dorsiflexion/stretch for 5 count

• BAPS on setting 4, clockwise x100, counterclockwise x100

• Balance board (finally able to use the taller one for everything!) plantarflexion/dorsiflexion x100, inversion/eversion x100

• Balance on op foot on balance cushion, Karate Kid style – non op leg bent at knee up high and arms out to side – x15 for as long as I can stand

• 10 laps walking lunges. 

• Sumo squats with 25lb kettlebell, up on toes at end of rep – 50
• New – weighted with 25lb kettlebell on each side, walk across room, going up on toe with each push off. This was hard and damn near impossible on my op foot. If it’s like everything else that I’ve done, though, I will see results in  how I handle stairs or other routine movements, and by next session I’ll be better at the actual exercise. 

Having read about many others’ post op experiences, I have to say, I am really grateful for being a best case scenario case at this point. It’s great to have a physical therapist I trust, that knew my abilities pre op.