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milesenoell
Sep 30, 2008, 4:12 AM
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I recently had my ankle reconstructed (folded it to the outside and broke the lateral maleus off and ripped all the tendons and stuff pretty good) which despite being one of the worst injuries of my life seems to actually be rather common. I was hoping that maybe somebody else has been through this and had some tips on rehabbing it. Any physical therapy routines or training approaches were what I was thinking, but I'm also just curious about background stuff like how long it's likely to stay sore or if I should take glucosamine/chondroitin for it. Anybody been through this?
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thatguyat99
Sep 30, 2008, 6:12 AM
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i had a similar injury...fracture of the fibula and total dislocation of the ankle...surgery, screws, a plate all to hold torn tendons and ligaments in place...
before i was off the crutches i pedaled a stationary bike with my "boot" on like 3 days a week. and used those big rubber bands as resistance while moving my foot in different directions...you can get those from your doc most likely.
after the crutches, i swam with fins on. also did exercises in the pool. calf raises, lunges, hop from one foot to the other, side stepping, "running"...in deeper water at 1st then more shallow as you get stronger.
i was able to move on to weights pretty quickly but kept up the work in the pool...and kept pedaling...i was able to start playing pick up games of basketball 3 months after i dropped the crutches...
my advice...be aggressive and be prepared to face a lot of pain...but give yourself rest days. you will have a lot of swelling during the rehab phase...i taped my ankle for about a year and a half for stability...if you use it it will get better and stronger.
good luck and don't forget your vitamin I!
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milesenoell
Sep 30, 2008, 7:20 AM
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Yeah, it sounds like it's going to be a grit-your-teeth kind of physical therapy, but hearing that you were back to playing basketball pretty quickly sounds encouraging. How long after the surgery were you using the crutches?
So far it's been about a month since the surgery, and I'm doing the range of motion exercises that hurt like hell, but they put in a long screw that goes all the way through both leg bones at the wide part of the ankle (in addition to the plate and six little short screws) that restricts some of the motion. The big screw is going to come out in a few months unless it breaks, which would be good because then it doesn't need to come out. Weird stuff. Did you have this long screw put in? Did it break?
(This post was edited by milesenoell on Sep 30, 2008, 7:22 AM)
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thatguyat99
Sep 30, 2008, 4:43 PM
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Yes I had the long screw...through the fibula and tibia.
And it did reduce my range of motion. No it never broke although there were a few times I thought it did.
I was up and about on the crutches but with no weight on the foot a few days after my surgery. I tried to start weighting it a bit here and there but not much. The pedaling I started about 2 weeks after surgery. When I asked my doc if that was ok, he said, "Oh, you're going to be one of those patients." I took a calcium supplement(powder in a smoothie or shake) everyday. The doc told me 8-9 weeks on crutches...the 7th week they were gone. The screw came out around 10 weeks after surgery. So I started all the stuff in the pool with the screw still in.
Keep doing those range of motion exercises. One of your biggest enemies is scar tissue building up around the ligaments and tendons. I credit that and the pedaling with keeping that at bay and I'm also convinced that the pedaling gave me enough resistance to strengthen bone, muscle, etc. and make healing quicker.
If you have a bike, I recommend buying a rear wheel trainer. That's what I put on my mtn. bike. I could go maybe 10 mins at 1st...and it hurt really bad. But the body is amazing and it will adapt...I was up to pedaling for an hour by the time I was getting off the crutches. Just be sure to take a rest day. Your ankle will need it.
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thatguyat99
Sep 30, 2008, 4:48 PM
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Oh...another thing. Probably the most important.
Keep your spirits up. With the injury, the rehab, and all the pain that goes with it it's real easy to say screw it and let yourself go. I have friends this has happened to. Way worse to try and come back after the injury has healed and you have let yourself go for a year. Keep your focus,
keep positive minded folks around, and see yourself in your mind back doing what you used to. It's funny, but a positive attitude really does work.
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milesenoell
Sep 30, 2008, 9:20 PM
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I can identify with the part about working on keeping a positive focus. It can be hard. Thanks for taking the time to help me out on this.
I was wondering, do you start out pedaling in the normal position with the pedal under the ball of the foot, or do you work into it?
Thanks again for such clear and specific answers.
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thatguyat99
Sep 30, 2008, 10:03 PM
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I wore the boot while pedaling. I'm assuming they have given you something similar. That you can take off and put back on?
I tried to keep it in the normal position as much as possible. It was only near the end with the crutches that I even attempted to pedal without the boot on.
Just curious...where in Oregon are you?
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milesenoell
Oct 1, 2008, 12:15 AM
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They gave me a removable boot, but I tend to only wear it to sleep or if I'm going to be doing stuff that might knock it.
As for location, I have lived in Eugene, Oregon for years, but now I'm moving away. I actually broke my ankle a week before I was planning to move. I don't recommend moving out of your house right after having your ankle reconstructed. Now I'm hanging out in Seattle at my brother's house waiting for it to be six weeks from surgery, 'cause that's how long you have to wait to fly after having a lower extremity worked on (so you don't get a blood clot and die of DVT). But in a couple weeks I'll be moving to Fiji. It's a really nice place, but I'm told that there aren't any climbable rocks, unfortunately. It should be good for rehabbing it in the water though.
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thatguyat99
Oct 1, 2008, 6:22 PM
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Fiji? Wow...enjoy that. Sounds nice!
Haven't been to Eugene. I hear it's a cool town...those college towns usually are.
Well I was going to say that when I come out to the PNW next summer I would look you up for some climbing but instead I guess I'll have to get to Fiji sometime for some surfing...Oh wait...I don't surf.
Well good luck with everything. Get that foot back in shape and enjoy Fiji. If you have anymore questions about what I dealt with rehab wise or whatever just hit me up. Later.
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onceahardman
Oct 1, 2008, 9:30 PM
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In reply to: I was hoping that maybe somebody else has been through this and had some tips on rehabbing it. Any physical therapy routines or training approaches were what I was thinking, but I'm also just curious about background stuff like how long it's likely to stay sore or if I should take glucosamine/chondroitin for it.
I wanted to respond to you earlier, but didn't get around to it. It's not so simple as "do exercises A, B and C".
You really should see a good, exercise-based, hands-on PT who treats athletes. Rehabilitation from this kind of injury really hinges on good assessment, and responding to changes as they occur (whether these changes are good or bad).
In the early, non-weight bearing phase, though, it's pretty much a matter of getting things moving (remembering, of course, that you don't want to get a fused or screwed-together joint "moving").
Once you get to the WBAT phase (= weight bearing as tolerated), you can start to make some serious progress. WBAT doesn't really mean to do as much as you possibly can, it means do as much as you can, without making it worse. When you start weight-bearing exercises, you will have lots of pain, and mild->moderate swelling. Severe swelling is a clear sign you are doing too much. This swelling phase will gradually improve over 2-6 months.
I hope this was helpful. The real answer is, you have to let the PT do his/her job. Even though I'm a pretty good PT, and know exactly what to do, if I was in your shoes (no pun intended) I'd go see a PT for sure, just to get some more objective eyes looking at it.
This is your last, best chance to optimize the function of your ankle, for the rest of your life.
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milesenoell
Oct 1, 2008, 11:45 PM
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My situation is a little different in that I'm moving to a place that doesn't have PT's or orthopedists, and ibuprofen requires a prescription (but codeine cough syrup doesn't, go figure). So, I am hoping to collect enough info to make decent decisions as they come up. Plus, I am hoping to get back to real climbing, and have doubts that the standard recovery track is aimed at that. So far, they just gave me a xeroxed page that said to do the alphabet with my big toe. No time-line or any real info.
Are there any benchmarks or ways to evaluate swelling to decide if it counts as moderate or severe?
As it stands now I'm about a month post-surgical and the swelling is under control, but has never gone down to anything resembling the other ankle, so I'm not sure where to think of as baseline. I know that the ROM exercises are critical, so I grit my teeth and try to get as much range back as I can, but it seems to be driving the swelling/reduction cycle. Should I maybe take a day or so off of the ROM to see if it comes down further? Is this all just a concern for when I start putting weight on it, but not important for just ROM?
Frankly I was really hoping to add some light resistance on a stationary bike as-per the suggestion above.
I'm scheduled to go back and get an X-ray in about two weeks (right before I leave the country) which I hope will come with some more info about the time-line. That will be at 6 weeks post-surgical and I assume that they will then tell me to start putting some weight on it, but I'd like to be pro-active about this as much as is helpful.
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onceahardman
Oct 2, 2008, 2:53 AM
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I see.
Well, for some reason, post-surgical ankles often don't follow the usual rules regarding swelling. Most joints, doing a little ROM (your alphabet exercise) won't increase swelling, but in the ankle, it's not uncommon. Do a lot of them. Every few hours. You are probably OK to start with some resistance bands, in four directions. (plantar flexion, dorsiflexion, inversion, eversion). For inversion and eversion, its easy to do them wrong, make sure you are isolating the ankle, and not rotating the hip.
Once you are weightbearing, you will progress from two crutches, to one crutch, to a cane. Use the single crutch/cane on the opposite side from the injury. Focus on landing on the injured heel, rolling through, and pushing off the ball of the foot. Often, patients will land on a flat foot, or on the ball of the foot. This will lead to gait deviations, and possible injury to the tarsals.
Eventually, you will want to progress to balancing on the injured foot (time yourself to see objective improvement) then finally to balancing one foot, with your eyes closed. This process could take 2-6 months, or perhaps even more. You want equal single-foot stance times bilaterally. Some never get there.
Back to swelling. The most accurate way to measure swelling is water displacement. Completely fill a bucket, step in, and measure the water lost to get the volume of your foot. Compare before and after exercise. Also compare to opposite side.
Or, less accurate but less messy, learn how do do a figure 8 measurement of the ankle from a PT here, before you go.
Good luck in Fiji. Stay in touch.
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milesenoell
Oct 2, 2008, 3:41 AM
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Wow, every few hours for the ROM. OK.
As for the inversion and eversion, I place a hand on my knee so I can feel if it and make sure I'm not moving it, so I think I'm doing them right. My main problem area for ROM is the lower left quadrant, so I sometimes start with an eversion and then rock it down as much as I can. Do you see any issues with this approach?
I took today off from doing my ROM to see if the swelling would go down significantly, but it didn't really. It seems that baseline for my reconstructed ankle is just bigger than my other ankle. I'll get back on the ROM exercises, and try monitoring it with the water displacement.
Earlier you mentioned being careful getting a screwed together joint moving. Any specifics to avoid?
Thanks for the clear and concise feedback.
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onceahardman
Oct 2, 2008, 12:06 PM
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In reply to: I'll get back on the ROM exercises, and try monitoring it with the water displacement. Earlier you mentioned being careful getting a screwed together joint moving. Any specifics to avoid?
You should be able to "eye up" the swelling pretty accurately.
Regarding getting things moving, if you are just using your own ankle power, you'll be fine. Sometimes overzealous PTs get too aggressive with mobilizing a joint that has been surgically modified not to move.
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milesenoell
Oct 2, 2008, 10:39 PM
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The swelling is my primary source of doubt when it comes to assessing things. I took some pics, but I'm waiting for them to be accepted onto this site. They show my ankle in it's least swollen state, next to my other ankle. They are still very different looking.
One thing that I was also curious about is the incision. When I moved out of my house it swelled up really bad and I think it may have caused the incision to open up some, primarily the bottom half of the incision. The top half of the incision healed a while ago, but the lower part continues to drain very small amounts. It doesn't smell like infection (putrid) but it definitely smells funky. I'm on a second round of steri-strips, but they are starting to peel and the lower part of the incision is still pretty moist. I keep the boot off most of the time, as they told me that keeping it dry was important, but I was just wondering if it was normal for the lower part of the incision to take significantly longer to heal like this.
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onceahardman
Oct 2, 2008, 11:33 PM
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Your incision is still open (or has re-opened)?
Dude, call the doc. Make sure you don't have an active infection. Slow healing is one thing, but infection is life-threatening. I would not leave the country with an active infection.
Put all the exercise on hold.
What is the discharge (drainage) like? clear or pale yellow liquid? Is there any pus? Redness around the open part?
Smell is not a reliable indicator of infection. Putrification of tissue is different from infection. Get it checked out, your life may depend on it. If your surgeon won't see you, go to your regular family doc, or the ER.
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milesenoell
Oct 3, 2008, 1:58 AM
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There doesn't appear to be pus, and I don't think it's infected. The steri-strips cover it so I can only see the bottom centimeter or so where the steri-strips are starting to peel(and aren't as well stuck due to the moistness). I went back in at about three weeks post surgical, because I was worried about the smell. I pulled the steri-strips off wiped it down with alcohol, and was going to put neosporin and bandaids on it but called to check before continuing. The said comne in and have them look at it. The nurse poked it and sniffed it and was satisfied that it wasn't (too?) infected, so she put a second round of steri-strips over it and told me to keep it dry. I was able to see that the two sides of the incision weren't very well connected. One side kind of stuck out a little more than the other, but it didn't look pussy or like there was any pocket. Since then it doesn't seem like I've healed much. The edges were red but, the redness was pretty localized.
Do you think that doing th ROM exercises is tugging the wound open? I thought that might be happening.
As for discharge, it's not super-oozy, but I wear a compression stocking that gets little spots from the drainage, and after a couple of days it starts to be a little yellowish goober.
Are band aids not appropriate? Would it be bad (or just not helpful) if I removed the steri-strips to clean things up?
(This post was edited by milesenoell on Oct 3, 2008, 2:03 AM)
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onceahardman
Oct 3, 2008, 3:50 AM
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In reply to: Do you think that doing th ROM exercises is tugging the wound open?
This is certainly possible.
In reply to: Are band aids not appropriate? Would it be bad (or just not helpful) if I removed the steri-strips to clean things up?
These are questions for your surgeon.
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asiaclimber
Oct 3, 2008, 4:44 AM
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yeah the Dr's told me that my leg wasn't "too" infected when it was doing that. that was 2 months ago... 3 weeks in a hospital under quarintine due to a bacteria called seratia 2 more surgeries to remove Nicrotic tissue (most of the back side of my leg and my entire achilles tendon) and i am wondering if i shouldnt have pushed the issue. Not to try and scare you but if you think something isnt right get a secund opinion.
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thatguyat99
Oct 3, 2008, 1:06 PM
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Hey...just to add to what they are saying.
My incision healed rather quickly. I want to say that within a week or so it was fine as far as not pulling apart or anything. It only drained for about 4 days and then it started to seal up nicely.
Don't mess with the possibility of infection. It will inhibit your recovery time and could put you in a worse situation.
Definitely see a doctor or call your surgeon. It doesn't hurt to err on the side of caution.
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milesenoell
Oct 3, 2008, 3:20 PM
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I'm going to go have it looked at today.
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milesenoell
Oct 4, 2008, 2:22 AM
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Woo-hoo! I saw a doc and she said that looks like I am just healing slow, but not in any real danger. I guess that when I moved I was too active and on my feet too long, causing the lower wound to pop open a bit which really retards the healing process, but that it isn't infected.
Thanks very much for all the input and suggestions you guys have provided. I'm really looking forward to getting the go-ahead to start doing resistance training, when I'll get to actually use most of the rehab suggestions. For now it seems that I'm mostly just spinning my wheels looking for something to do since I've been unable to get out and do any of the activities that keep me sane.
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thatguyat99
Oct 4, 2008, 4:31 AM
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Good deal my man. Glad to hear that it's ok.
Take care of that thing!
And good luck in Fiji.
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photonicgirl
Oct 6, 2008, 12:35 PM
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Hey there. That ankle issue is a tough one. Mine rolled when I was 12 (roof jumping) and now I'm very actively almost 49, still dealing with it.
Here's my two cents towards recovery:
A doc in San Francisco gave me PT that involved a babs board (round) that you move around on and maintain your balance. Add to that a bongo board, same thing only side to side, and slide board, which slides like skiing. Strengthens the outside tendons and/or helps with muscle memory.
Also, write the alphabet with your foot. That's an old climber's trick I heard about, and it's pretty hard actually.
Be prepared to always wear high ankle boots when hiking and doing things that require a lot of tough walking/hiking. If you snowboard, get really stiff boots. The reason is, once you've rolled your ankle post-surgery, it's worse. I've rolled mine about 25 times just to give you an idea.
As for Fiji, I lived in Hawai'i for a year. As an active surfer in coral reef country, I found out about staph...don't get it. Make sure your wound is fully closed, i.e., not leaking at all before setting foot into the ocean.
And be happy. So what, you have an injury now that will change your life forever.
Join the club!
Peace,
Jules
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milesenoell
Oct 6, 2008, 4:37 PM
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I've lived in Fiji before, and can definitely hear you about watching your ass around coral, and keeping wounds clean. I've got enough coral scars even without any serious infections. (knock on wood)
The PT tools I'll have to improvise, since that kind of thing isn't available over there. The babs board... is that the same as a wobble board with the soft hemisphere on the bottom?
So far I'm doing the ROM stuff (circles, up/down, left/right, and alphabet) but no resistance or weight bearing yet, so I've got some time to figure out how to rig something up.
Thanks for the input.
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