physical therapy - not as bad as it's rumored to be

I started physical therapy a couple of weeks ago. The experience so far has not been quite what I expected. To be quite frank it has been rather anti-climatic. I wasn’t quite sure what to expect but I did think there would be more things to do once I got there. I’m very goal oriented so I wanted to be doing something –preferably exercise related with quantifiable reps. I was also prepared for pain, after all we’ve all heard PT horror stories from co-workers, friends etc ., and they always use the word pain somewhere in their descriptions. The good news is that, up to this point, there has been no pain. The bad news is that Der Kommandant (and yes my exercise friends do call me that) has not gotten a lot of exercise at PT yet. I have been given a set of exercises to do at home - most of which I had already been doing anyway.

At my initial visit my physical therapist measured my ankle six ways to Sunday to determine the ankle’s size and range of motion. Frankenfoot is 2 inches bigger than the normal ankle and, oh joy, I have a negative three on the dorseflexion scale. The plantar flexion wasn’t so hot either but at least we weren’t in the negative there. Dorseflexion, for you children at home, means how far one can point one’s toes upwards. A negative three basically means I’m screwed, at least for the time being. She also pointed out the muscle atrophy in my calf. I had to restrain a little bit of sarcasm there as no one comes out of a cast with nice lookin’ calf muscles. She then handed me a sheet of exercises to do at home and I had her watch me do two of them. We ran into a bit of a catch 22 as I could not bend my knee enough to do one of the exercises and she told me that this was due to the dorseflexion being so bad but that I had to do it properly to increase dorseflexion. Still not sure what I’m supposed to do to this day but keep giving it the old college try. After all the measuring I then got a nice foot massage and sat with my foot in hot water for fifteen minutes with electrodes in the water. I never did feel any tingling from the electrodes. She did give me one good piece of information though and that was that I was bringing my bad foot up and then stopping and bringing the good foot up to meet the bad foot. I’ve since been trying to walk with more of a stride. I did tell her that I’ve never had a “normal” gait and that my mother used to describe my walk as “jock with polio”. Also ,judging from the wear in my shoes I’ve never used the ball of my foot, ever. This might explain the tight heel chord the OS always talks about. Currently, even though I’ve gotten rid of Hermann, I am walking pretty much like Frankenstein’s monster, sigh.

My subsequent two visits were similar to the first visit sans the measuring and with the addition of five minutes on a stationary bike. On visit number four though I did get to do something new. The PT had me pick up about 30 marbles with my toes and put them in a box. I didn’t have the heart to tell her that I’d already been practicing this exercise with ball bearings. She also had me use a roller under my foot which felt pretty good. Sadly though, while the increased activity has lead to some really eye-popping swelling of the ankle (with the oh so fashionable compression sock on I might add) I have not seen a lot of improvement in my gait and this has lead to some pretty severe depression on my part. I’m hoping to shake that soon but at the moment it is pretty much Bleaksville in ankle city. Hoping to report better news in the next couple of weeks

three month ankleversary

November 1st was my three month ankleversary and I went in to see the orthopedics doc for what the next step might be. I started my usual ritual at check-in by inquiring if I was now listed as a worker’s comp patient. The standard reply was that, yes I was in the system as worker’s comp. It seems that no matter how many times I ask this in any given visit that the incorrect insurance company and/or myself will receive these horrendous scary bills. Nevertheless one has to give it the old college try in the hopes that one day things will be correctly billed.

The second step was to take the usual set of three x-rays. To my surprise however I was not going to be lying on the pallet for these but rather standing. The tech told me that not only would I be standing sans boot but that I would also have to climb up onto this tiny weird looking step. Yeah, right since going up and down steps had already been so beneficial to my ankle. However, I gamely climbed up holding on to various pieces of X-ray equipment with a death grip. After many, many repositionings I was allowed to step down and resume the safe embrace of Hermann aka the boot. I do have to say taking even those small steps without the boot was the weirdest feeling ever, it was indescribable how the linoleum felt on my foot.

The doc then came in and then told me my ankle looked like it was healing well. As an aside here I should mention that I am being treated at a teaching hospital. Since it is one of the best in the country I’ve had no concerns about the quality of treatment. What I do love about it is that you are never quite sure who will be in the exam room with you on any given day. I’ve always been fortunate to see my surgeon but on various occasions he has brought in a medical student – who was a bit of a mumbler and who kept looking at the floor. He also had a clammy handshake so I’m not sure he is cut out for the life of a surgeon unless his confidence level is raised considerably. On another occasion he brought in one of the pack of residents previously seen in the hospital. It was not the incredibly good looking but brutal handed one but one of the quieter ones. None of these folks are what I’d call talkative. They tend to give you the bare minimum of information and it is then up to you to burrow out any further nuggets of wisdom. Fortunately, this time, it was just the doc and a P.A. P.A.s tend to be more communicative as a rule so I had hope that I’d learn more than the usual, “x-rays are looking good” statement I usually receive. Sadly this was not to be the case. Instead ,just as a diver looks for pearls by prying open the oyster I had to pry , with words, but gently. I found out that yes, it is okay to wear compression socks to reduce swelling; I can resume Yoga; I can, if I feel confident enough resume riding my bike. Personally I think we are being a bit premature on the whole it’s okay to ride your bike thing. It is a good thing I’m not a gung ho athlete as I can just see someone leaping on their bike only to go for a dismount and then Crack goes the ankle. I amy give the stationary bike a go though to help rebuild the calf muscle.

The other big piece of news the doc imparted was that I could get rid of the boot and begin walking without it, “as comfortable”. I always love the “as comfortable” bit as I am such a cautious Nelly that I’d probably stay in the safety of the boot forever. I asked him to elaborate on that statement (remember you, the patient must burrow for additional info) and he told me to not wear the boot unless I’d be walking for long distances and that wearing the boot for these types of trips might be beneficial. I then asked about the pain I was having at the forefront of my foot and it turns out that Hermann might not be the security blanket I had thought he’d been. That bad boy had helped cause metatarslagia. I had evidently been putting almost all my weight on the bad foot on the ball of my foot and since Hermann is pretty unforgiving in that area it caused inflammation. Suddenly I now had no desire to continue in the boot. Good bye boot, hello too tight tennis shoe!

We’ve now been boot free for a week and while I cannot say I am loving it I have discovered that not being in the boot and liberating myself from the walker has been somewhat freeing. I actually weeded the front portion of one of my flower beds, was finally able to clean my kitchen properly and even managed to do some laundry. In order to use the washer and dryer I have to go down a step, one tiny, tiny measly step but until Sunday that step was my Mt. Everest. I am happy to say I conquered Mt Everest and went on to “climb” the front steps. Who knows what I’ll accomplish next. I feel like I missed out on so much. Summer is gone and now it is almost Thanksgiving.