3 months post ankle/tibia surgery

Boo, my whole foot, especially my heel and achilles over to my lateral ligaments, is one big writhing mass of nerve and fasciitis pain. My toe has actually been doing the best now. I've had to cut back on how much weight bearing I'm able to do right now because of the increase in pain and that is helping my discomfort. I still have 1-2+ pitting edema despite the Jobst stocking and lymph massage. My foot up to mid tibia turns bright red and if I touch it does the flash of white and turns right back to red when it flares up. I'm not quite certain yet, but I think my incision that opened and had to be treated healed too tight. The line is puckered and feels like it's pulling. It didn't look that way before the cast was applied. It's so hard to tell right now because I can't weight bear without the boot therefore I can't tell how the ankle and foot are going to feel when walking bare foot. I'm 11 weeks post op now and still pretty early in recovering. I haven't had the most ideal recovery either so I have to keep that in mind too.

On the bright side, looking at my reflection is fun because I see myself with a straight leg. I will need to do a photo op to document my legs as I progress.

Great Gastrocs!

I am pleasantly surprised to find the gastrocnemius lengthening is actually doing what it's supposed to do! I start each afternoon (after work) with stretching and flexion/extension exercises with my ankle while also engaging my calf muscles. I had no idea how tight my calves actually were!! When I flex my ankle upward (toes to the sky) my calf just feels smooth and free on the right side/"fixed" side. When I flex on my left, the calf is tight and crampy feeling. It brought a smile to my face when I realized how nice it feels on the right side. Dr. B did tell me pre-op how tight and short my gastrocs were and that the lengthening would make a difference and help with cramping. I had no idea how right he was because this has just always been normal for me.

Day 75, or 2.5 months post op, and I finally see a really great improvement!

Small improvements

Each week I'm noticing small improvemts in my ankle pain. The incisions are tender to touch, but not exquistly so. If I palpate them hard they definitely hurt a lot but having materials touching my foot and ankle (clothing, blankets, water) does not hurt anymore thanks to neurontin.

My scars are hypertrophic and look a little bit like they have blood blisters under them but it's just the way they healed -- ugly. The incision that opened is still managing to stay closed but there is a really thick nasty scab on it and within the area of the scab is a big depression and around the entire incision is a lot of fluid. I'm still not sure if it's purely just pitting edema or if it's fluid that needs to be drained. Sometimes the area feels really hot, but it's never been red since the just after I finished my course of antibiotics. 

My ankle ROM is improving in small increments. At least dorsiflexion anyway. Plantarflexion still seems to be too stiff and I'm also having trouble spreading my toes. Some of that I know is due to the edema, another part of me thinks nerves are slow to wake up. My great toe has almost zero motion to it and it is still painful. The jury is still out but I'm not so sure this was the right thing to do to my toe. It hurt before but at least it moved and wasn't swollen. Dr. B did say it would take a year to get results. I really don't get how a foot surgery can take so much more time and energy to heal than a freaking hip osteotomy but, I digress.

I am up to 100 pounds of weight on my foot. I can walk around the house without my crutches in small, small increments even though I am absolutely not supposed to. I only put weight on the lateral side of my foot though. Putting weight on the big toe hurts!! Plus trying to walk with full weight (even in the boot) causes a surprising amount of pain anteriorly in my ankle. I'm just going to ride this one out because Dr. B said as I increase my weight bearing, if something hurts, I'm to back off and go more slowly. Who knew I'd be on weight bearing restrictions and on crutches longer for this surgery than my hip surgeries. When I go back for my next follow up, it will be just shy of 4 months since surgery and being on restrictions. I wouldn't mind all this so much if it weren't for the troubling edema. It's better but still bad/ugly. Even with the Jobst stocking on it during the day, it is still pretty significant. And that worries me. Swelling up after activity or having my foot down would be one thing. Having +2-3 pitting edema 24/7 is not normal.

I still have that little nodule on my achilles but it doesn't really bother me too much. It gets a little irritated when I put too much pressure on it but settles down when I take pressure off of it.

Vacation is next week and I'm ready for something fun. I'm also ready to use my "golden ticket"! My husband and his brother will be running in the Disneyland half marathon and then the real fun begins :)

Follow up to the follow up

I saw Dr. B on Thursday. Things went well enough but still on the slow track. I had xrays done and then waited for Dr. B to come in. He went over the expectations at this point in the healing process, and pointed out my recovery has been slower than usual. Slower in that I had more done in a smaller area which causes A LOT of trauma to the surrounding tissues. The bone is still not healed. The incision is closed but still needs close monitoring because of the swelling. The swelling is +3 pitted edema, which he was a little concerned about a DVT since it was always swelled and not better in the morning and worse in the afternoon/evening (we ruled out a DVT with an US). Because of the swelling, he prescribed Jobst stockings in 20-30 mmHg strength and I just got those yesterday.

So, I'm to stay in the boot for 6 more weeks until I see him again (typically it would be 4 weeks) and I have to remain on my crutches til then. I can start slow weight bearing of 50 lbs for a week, then 75 lbs for a week, then 100 lbs for a week, then full weight. However, I can only weight bear in the boot, not while I'm out of it. I can't start outpatient PT until after I see him either, but I am allowed to do PROM as long as it doesn't hurt. 

I started wearing the jobst stocking yesterday and by evening was feeling an irritating pain on the back of my heel, on the achilles. This morning it was unbearable and when I removed the boot and took off the compression stocking, there was a peanut sized nodule/lump and it was red. Any pressure on it hurts so I can't wear the boot or stocking right now or rest it on a surface either. Pretty miserable. These inflammatory nodules are a hallmark of ankylosing spondylitis, so I'm thinking I'm getting a nasty flare of that because I also recently had a few ulcers in my mouth and really bad back pain. On top of that I am really struggling with my blood pressure. I'm light headed and falling over, especially in the mornings and after sitting/lying awhile. I've been checking my pressures and the highest reading I got over the last several days is 87/40. I'm increasing my water intake to try to help. This has to get better quick because I can't balance myself well with little to no weight bearing, and I've had 2 falls recently. 

Overall, things are looking better but vacation is in 2 weeks and I wanted to be walking without crutches by then. I'll be lucky to be walking without them by the time the fall wedding I'm in rolls around!