Ankle Rehab: Finishing up Week 3

So, what does it feel like to be three weeks off crutches? My mobility is quite good -- most of the time I can walk normally, although when I first stand up after sitting for a long time or after a long stint on my feet I do limp. What causes the limp? There are two things: first there is now a fairly constant pain on the outside of the ankle. The PT says this is pretty normal, and she didn't find anything wrong. Second, the ankle still swells a lot. After standing for a reasonable length of time, it will look like someone glued a clementine to my ankle. That swelling causes restricted mobiity and also stretches the skin and makes my heel hurt.

Speaking of heels -- this whole episode seems to have triggered plantar fasciitis in both feet. On the left (injured) side, the sprain causes muscle tightness in the achilles and calf, which in turn puts strain on the plantar fascia. On the right side, it's less clear. I think that the strain of being one-footed and hopping around a lot put undue stress on the right foot and triggered some inflammation. At this point, I don't see the right side doing any extra work, but I can tell you I'm worried about plantar fasciitis on that side.

PT sessions are both challenging and enjoyable. I spend 5 minutes warming up on a stationary bike and then do a variety of strengthening and balance exercises.

Some of the more entertaining ones:

1. Stand on the weak leg and do resisted movements in all four directions with the good leg.
   
2. Stand on the weak leg with a tilted trampoline about six feet away to my left (weak) side. Now play catch with a 2-pound medicine ball, bouncing it off the trampoline.
   
3. Do squats on a rocker board (this is kind of cool -- the board just rocks like mad even if I'm feeling kind of balanced).
   
4. Stand on rocker board and play catch with a 2-pound medicine ball.
   

After all that I do some stretching and then ice the ankle for ten minutes. Up until this week, we were also doing estim with the icing, but that doesn't really seem to be having an effect, so she stopped doing the estim. From what I can tell, I'm about to plateau -- it's clear that I've got good range of motion, but there is still a fair bit of strengthening to go. I think this is about the time when the going is about to get rough, but we'll see.

Ankle Rehab -- end of week 2

I finally had my PT evaluation last Thursday (4 days ago). I'd been pushing pretty hard on flexibility and strengthening, so I was able to walk into the place with only a minor limp. The limp seems to be caused mostly by the swelling in the ankle that prevents me from flexing properly when I walk. However, as I learned, I am capable of flexing more, so it's just a question of forcing myself to do so.

First, overall status: I can spin bike now for 30 minutes and figure that it's no longer the ankle that's holding me back there, so I might as well just bite the bullet and go back to a real cardiovascular workout. Even though I spent 6 weeks on crutches using a lot of upper-body strength, I can no longer do the sets of bicep curls I could do before -- sigh, back to the weights too. However, I'm getting some decent strength out of the ankle and I can balance on it for at least 10 seconds (neither the PT nor I wanted to push much more than that right now).

My physical therapist took a lot of measurements to quantify just how limited my flexibility is -- plantarflexion (pointing the toes) is the worst (about a 15 degree angle instead of a 45 degree angle), although dorsiflexion (toes to your nose) isn't much better -- I can get 3 degrees past neutral (as opposed to 20-25 on the other foot). A figure 8 around my foot and ankle is 2 cm larger on the left (swollen) side.

Basically all good progress, and I promise to write about things other than my ankle real soon now!

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.