Long ago (1988) I moved to Berkeley and started sending a monthly "newsletter" to my Boston friends. When I returned to Boston (1993), I continued the tradition for about five more years (or until I had kids). Looking back, I realize that I was actually blogging. Each newsletter contained anywhere from a few to several blog posts. Having been silent for the past decade or so, I've decided to resume these activities. Don't expect anything profound -- I tend to focus on what I find entertaining or amusing and perhaps sometimes informative. We shall see!

Wednesday, June 9, 2010

Ankle Rehab from the Inside

After 25 years of playing adult recreational soccer (having never played in high school or college), I had my first serious injury on April 25 -- a broken fibula and tibia (OK, so the tibia only broke off a small portion of the lateral condyle, which is the knobby part at the end of a bone). Yeah, yeah, I'd ruptured my plantar fascia the previous fall, but that was nothing compared to this.

Anyway, as I have just gotten the cast off and am beginning rehab I find myself wanting to know what this is going to be like, what to expect, what others have experienced, etc, and you know what? Amidst the morass of information that is the web, it's not easy to find a real personal account of ankle rehab -- I mean Carli Lloyd busted her ankle the same day I think -- I'd love to know what she's doing (OK, my rehab is likely to be slower, but hey, it's important to have goals). So there you have it -- this has inspired me to begin blogging (and I apologize for the length of this first entry; they'll get shorter). I'm not the only one in the world who wants to know this kind of stuff, right?

Now, before I begin -- a word for all of you out there who believe the old wives' tale of, "Oh, you're lucky it's broken; broken ankles heal so much faster and better than sprains." I suppose in some universe it might be possible to break your ankle without spraining every ligament and straining every muscle in the ankle, but get real. Most of the time, breaking the ankle is only possible after you've done all the damage of spraining all the ligaments. What does this mean?

After being immobilized in a cast for six week letting the bones heal, I am only now beginning rehab that has been necessary since day one -- and guess what? The longer you wait to begin rehabbing a sprain the longer it takes. See that pretty sprain picture from a light sprain two days after injury? Mine looked worse than that after six weeks. So the next time you are tempted to tell someone how lucky they are to "only" have broken their ankle, bite your tongue -- hard!

Anyway, where were we -- OK, broke the ankle on April 25 and spent the first 2 days in a knee-high walking boot (no weight-bearing) followed by 5 weeks and 6 days (who's counting?) in a regular old knee-high fiberglass cast. The orthopedist gave me the option of staying in the boot, but the cast is lighter and immobilizes the ankle better, leading to better healing, so I went for the cast (good choice).

A public service announcement about leg casts: no one told me this, but because my cast was getting large just as I was about to take an airplane trip, I talked to my orthopedist about flying and the cast. If you ever have a leg cast, do not fly without getting the cast cut in half and then wrapped with an ace. Legs swell while flying and can swell sufficiently that the cast cuts off circulation. Let's just say that the combination of that kind of swelling, a hard cast, 30,000 feet and TSA regulations can lead to a pretty ugly ending. It's not worth the risk.

Anyway, June 7 arrived and they took my cast off! Yahoo -- 6+ weeks on crutches was plenty for me. It's not the getting around part that drove me crazy, it was the not having hands free to do anything part. A closed soda can? No problem -- toss it in a backpack, but open it and now you just stay where you are and drink it, because you aren't moving anywhere with it (unless you like bathing in soda)

Upon removing the cast you discover that your leg is furry (6 weeks of hair growth), flaky (good news: new synthetic cast liners don't absorb so much moisture that your leg itches; bad news: you still shed 30,000-40,000 skin cells per minute -- do the math -- there is a lot of dead skin on that leg that hasn't seen the light of day for 6 weeks), and fleshy (muscle atrophy). A good shower and shave takes care of furry, improves flaky, and emphasizes fleshy.

In my case they put me in a fancy sports aircast (which requires no inflation), but your mileage may vary -- I've heard some people go back in a boot for awhile. Then they say good bye and you (try to) walk out. This walking thing -- very odd. Much to my surprise, the foot is still (very) swollen, sufficiently so that stepping on it causes the bottom of the foot to hurt because there is so much fluid in there. Hmmm, wasn't expecting this. Ankle doesn't hurt, but foot does. This is probably good news -- after all, how long can this stay swollen?

I walk with one crutch for the rest of that day -- full weight bearing is too painful on the foot, but the ankle actually feels OK. This is good news, I think. In fact, walking with shoes is considerably more comfortable than walking barefoot, because the floor is, well, hard.

I expect to wake up day 2 and find that swelling is gone. Oops -- no such luck... however, bottom of foot is not quite so painful. I head downstairs and decide to try: 10-12 minutes on the spin bike with very light resistance (this feels OK), and ankle exercises:

  1. pull back on towel around ball of foot -- hmmm can't really get much flex in that old ankle
  2. standing calf stretch -- can't stretch ankle enough to even feel it in the calf
  3. standing achilles/soleus stretch -- ditto
  4. Mobility exercises -- something resembling a circle not so bad

OK, we've got a long way to go! I don't start official PT for 10 days, but I am determined to make progress before then

By the end of the day, I am walking mostly without the crutch. I find that I'm causing more strain and imbalance using the crutch than I am simply by walking slowly without it. The problem continues to be more the bottom of the foot than the ankle itself.

Day three (today), I see that my foot looks almost normal -- there is still some swelling, but it is noticeably less. I abandon the crutch -- I am now a free-walking individual -- such liberation! I have not only one free hand, but two! Yippee!

I can walk upstairs like an adult -- one foot on each step -- perhaps I'm putting a tad more weight on the bannister than is normal, but I could almost pass for a normal human being going up the stairs. Down is still tricky -- the ankle doesn't yet bend that way -- it can't really flex forward. I miss getting up early enough to do spin bike, but do my ankle stretches again. This time I push hard to get something resembling a calf stretch -- I'm still not stretching the calf, but I'm now feeling the pressure in my ankle and the achilles/soleus stretches are downright painful -- good painful, not bad painful. It strikes me just how much hard work lies ahead (I'm not a big fan of pain).

Range of motion is getting better -- I can both flex and extend the foot just a tad, and side to side motion is actually quite good (once I remember how to do it -- seriously -- it took a minute).

Most of the bottom-of-foot pain is gone (slight remnant) and my uneven gait is mostly due to the stiffness in the ankle. My pace yesterday was snail-like; I think I've now moved on to turtle-like.

20 comments:

  1. Thank you for writing this, im in my fourth week of having a cast on and it is so refreshing to see how much improvement you have had in days not weeks!!!

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  2. I broken my ankle really bad March 27th, had cast on and was in a boot until the beginning of June. My calf is still significantly smaller. Are you having this problem? If so--what can I do to help make it the regular size? Is it always going to be smaller?

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  3. Thanks for posting this commentary about your ankle break experience. My husband just got his cast off after 6 weeks and he's very unsure what to do. This information is invaluable. SO glad I found your blog!

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  4. Thank you for a very good blog. Your debunking of that old wives tale is great. I'm just out of the fibreglass cast after 2 months and it feels so good. There is still a lot of swelling and some pain but with the exercises , things can only get better.

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  5. how long did it take you to start driving again? and also what exercises did you do to stop yourself gaining weight while resting the ankle?

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  6. how long did it take you to start driving again? and also what exercises did you do to stop yourself gaining weight while resting the ankle?

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  7. very useful post...thank you very much. any update of how you are a few years later ?

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  8. Well I broke my ankle on Mother's Day of all days within like 10 minutes of waking up. I was at a hotel and went to get a bit of ice, but there was some uneven pavement and it dropped off about an inch that you couldn't see in direction I was walking. Ankle twisted and snapped on both sides(driving ankle too). I was in middle of driving from GA to TX and at a hotel in LA, 6 hours from destination and have my 16 yr old son and 3 yr old daughter with me. Had no money or place to sleep that night either as the only thing I had left was enough money for gas to get there. Took combined effort of some friends in LA and family in TX to get us and my car there all while sporting my painful broken ankle in cramped cars. Anyhow, I am diabetic, so thought I would add what more to expect if you are diabetic and if you have to have surgery. I had to have titanium plates and screws put on both breaks in either side of ankle. They put an open ended cast on it for first couple weeks. Meaning its casted up on all sided but front end is left open for swelling and wrapped in thick Ace bandages. After those 2 weeks, they took the staples out, applied bandages to incisions, and put me in a boot, with instructions not to get it wet and not to put any weight on it. Next appointment is 4 weeks later. Here I am hoping I can start putting some weight on it and be able to bathe better again. I can bathe(sort of with a some effort to get in tub and a LOT of very careful effort to get out). It helps to have a removable shower head to wash my hair while sitting in bath. However, because I am diabetic, it means 6 more weeks in the boot, for a 12 weeks or so total of cast/boot time with no weight supposed to be applied. I am supposed to practice moving my foot up and down and such to get some mobility back into it. If all goes well August 3rd I am hoping to have some semblence of normalcy again, but supposed to do physical therapy then too. Other than the stiffness, also feels like my ankle is turned in a little too. If I try to lightly stand on both feet, I feel like I am standing more on the outside edge of my foot, so hoping that it will straighten out a bit, especially with physical therapy over time. I won't know how things go until then, but if you think you got it bad at 6 weeks and not diabetic, feel lucky! I am going crazy here and I have to traverse a flight of stairs at least once if not more on a daily basis. I am just lucky I have some family to help me out a bit, but really want to start doing thing myself normally again!!!

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  9. Great share and informative post..!!

    When you stress an ankle joint beyond the strength of its elements, you injure the joint.

    The degree of pain, the inability to walk, or concern that a bone may be broken is what might cause you to seek care in an emergency situation.

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    1. I broke my tib/fib and ankle on R leg August 5, 2016. I wore cast 10 weeks. The next 4 weeks I had the leg brace but could start moving foot by flexing and I could put weight on it but not enough to break a boiled egg.December he said no brace and full weight. Maybe walk with walker a week then use a cane. Jan 12 I went in and xray showed all bones at 100% healed. My doctor said you're good. He said I no longer needed the cane. Ha! The thing is I never got to the cane. I was still on walker and I could only put maybe 50-60% weight on leg. And that was walking with my boot. I told him I couldn't walk without them and he asked was it in my head?!? I had horrible breaks. My tib was shattered. I have two plates and 25 screws and not much healing the first 3 months.he said he thinks I'm afraid and using the boot and walker as crutch. I told him I can not take a step without it. I asked for PT which was always in the plan. So he agreed to give me orders for 4 weeks at 3 times a week. Here it is Jan 16 and I'm no longer in my transporter chair. I'm using walker but in extreme pain as all the movement from being up and down has my ankle imflammed. My problem now is no free hands. My ankle is swelling bad and red with purple tint. Why would he think I'm ready to walk when I can't put full weight on my foot and leg. I'm calling to set up therapy this next week.

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    2. Definitely therapy. I couldn't wait to go to be evaluated and get a better word from someone who sees the end product and how it relates to your daily living. Once you leave the surgeon's office, he considers you healed. Unfortunately, he's done his job and it's time to move on to the next case, while you're struggling to make sense of the new world of Post Surgical. Good luck.

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  10. I walked around on my ankle for two weeks before I finally had it x-rayed, and not only was it broken, it was displaced. Surgery followed with a plate and screws (gag) and a temporary cast and ten days later, a fiberglass cast was on for 5 weeks. I have started PT, but I'm having a lot of difficulty with swelling after being upright for too long, purple foot up to my ankle, and pain on the inside of the ankle. Crutch walking is helpful to minimize the weight I put on the foot, but it is still too soon to do a lot. Also, that sprain thing you talked about- that's painful. But when that one area didn't respond to all the RICE, I gave up and went to urgent care.
    I'm 66, so it might take longer. I don't know, but I have to slow down, I guess. It's so liberating to have that cast off and not to have to be driven everywhere (I have developed a nice flow of right foot accelerator/left foot brake) that I got carried away.
    The other thing I wonder about is if anyone feels pain in their knee after not walking on that leg for so long. I lost a lot of muscle mass in that leg, so there's not much to stabilize the knee.
    Anyone else have these issues?

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    1. Hi. I'm 47 and broke my ankle on March 8, 7 and a half weeks ago. It was a bad one, dislocated and broken in 2 places as well as 3 metatarsal breaks and 2 fibula breaks. Plaster for 5 weeks then moon boot for 10 days with partial weight baring. Physio then told me to loose the boot and crutches and start walking at 6 weeks post op ( I had the ankle pinned). I had that knee pain too for a while but the worst thing was (is) the ankle stiffness and swelling. I can walk slowly and stiffly but the swelling puts me back on the couch after about half an hour. The Physio said I was doing really well but I feel like I'm going nowhere and progress is really slow. Swimming seems to help.

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  11. What an awesome post!! I just got cast off today (tib fib and crushed ankle, with torn ligament that has some ankle bone imbedded forever!) 2 plates 6 screws later I was shocked to watch it swell & bruise after it came off. Been in a cast 8 weeks. I find so much positive energy in your post cause I was super bummed about how much pain getting cast off and walking is. So glad it will get better. I put ace bandage, more for peace of mind. Shaved (woot woot) and finally got all the surgical pen off. That was enjoyable. but My Achilles tendon is like frozen. and that hurts.
    My dr told me no driving for THREE months after surgery uggggggghhhhh. Of course its my right foot.
    As for knee pain I have not had any.
    I wish everyone a short healthy recovery.

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  12. I really loved this post. It helped me to realize I'm not alone. I broke my ankle on both sides on December 10,2016. I have a plate and screws and that healed but I have three level three tears that are awful. My first dr. Just kept saying your fine just keep doing the stretches. The second dr. Found the tears and put me in a hard cast for 4 weeks. That came off today and I'm waiting to start physical therapy. Still very sore. You made me see a light at the end of the tunnel. Thank you

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  13. I broke both sides of my ankle (3 breaks on one side, 1 on the other) and dislocated it. I ended up in the hospital, with surgery the following day putting it back together with pins and plates. I was in a half cast for about a week, then switched to a full hard cast just days before going on vacation (from Hawaii to South Dakota) and wow it really swelled! Anyway, the doc cut windows on each side so the staples could be taken out while on the mainland. 5 weeks later the cast came off, and a boot went on. Still non weight bearing and no driving (broke right ankle) for 4 more weeks. I go back tomorrow and PRAY I am given the ok to start walking....and driving! I'm seriously going batty in this house. I haven't been able to work either, because of the nature of my job, so I have seriously been stuck in tbis house....ugh! I had only one session of PT, and then had to wait to get approval from the insurance company....I finally got it, but won't start until next week! She did however give me exercises to do, and finally I am able to move my ankle up and down and side to side. The only issue I have now is my Achilles tendon has been really hurting when I move my foot, and sometimes I get a really deep ache in my ankle still. Anyone else have those issues?

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  14. Thank you for this! Broke my ankle 6 weeks and 4 days ago, that's also how long I was in a cast. Here's to hoping that I can get it off today. A bit worried about mobility. In my mind, cast off equals to normal walking me. I guess not, huh.

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  15. I broke my fibula and dislocated my ankle 7 weeks in cast and been out of cast for 3 weeks now its still swollen abd bruising at ankle and the leg is sore inside. The worst is when stepping down stairs with the foot its so sore it cant bend upward is this normal? Will it loosen eventually? Ive started acupunture. Is this normal will the pain subside and will the foot nend upward again? Still have some swelling. Thanks

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  16. I dislocated (90%) and fractured my ankle in 3 places on 7/20/18. One week in a split, then surgery, a plate with 5 screws and a stabilizing screw. 2 weeks in a splint and not allowed to leave my bed (except to go the bathroom). Splint comes off, 4 weeks in a cast (non-weight bearing), 3 weeks in partially weight bearing cast. I am set for next week to move to a boot. This has been one of the toughest things I have ever been through, I lost all independence. I am hoping that once I am in the boot I can start walking with no crutches/walker. Thank you for telling your story!!

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