Thursday, November 24, 2011

Physical Therapy: Round Three

In the last two years I've had to rehabilitate my ankle twice.  Each round of physical therapy was four months.  With eight months of rehab under my belt, I thought I could handle round three myself.  I've seen all of the manipulations of the joints, the painful tendon stretches, and the strengthening exercises.

Turns out I don't know what I'm doing.  I start round three next week at CORE Physical Therapy.

The joints in my foot need a lot of work.  I'm not pushing myself hard enough on my own.  My foot is still very stiff and painful from reversing the contracture caused by being locked up for twelve weeks in an external fixator.  The contracture is clearly visible when compared to the much larger left foot.

The nerve damage in the ankle keeps the skin hotter than normal, quite red, and triggers the sweat glands to overreact.  While unlikely at this point, it's still possible to develop complex regional pain syndrome.  The neuropathy has died down significantly and feeling is slowly coming back.  All good signs.

June 2010 Ankle

November 2011 Ankle

The ankle is still feeling good, but it's important to loosen up the joints in the foot to ease the pressure on the ankle joint.  

The worst pain I have is when my blood pressure spikes -- something I've experienced regularly during the two rehab phases since the accident.  The pain from the inflammation in the foot is at its worst in the morning.  Ice and Celebrex are your friends.

The holes have almost completely healed.  A few days ago I had this sweet crater in one of my pin sites.  This thing was big enough to have its own gift shop at the bottom.  Fortunately, it has healed up since this picture was taken.

Hope everyone has a great Thanksgiving!  Since the accident I've had quite a lot to be thankful for -- not dying after snowboarding into a tree probably makes the all-time top ten list.


  1. Sounds pretty gross, but had that last pic been a video, I would have been half-expecting to see a little maggot peep out of the hole and wave hello.

    Happy Thanksgiving to you and your fam!


  2. Hey Tony! Thought you would like to know that I had my Dr. appointment lst Tuesday. It so happens I am elegible for the distraction. It will be in NYC early next year. For me it was a choice between Mercy or HSS. I finally chose HSS because they use a frame that is simpler and therefore requires less pins. Here is a link that might interest you:

    As the Dr. laid out his diagnosis I could not but remember your blog. Basically, there are parallels betweeen your injury and mine. After a succesful ORIF everything was bright until a bad bug decided to have a party in my distal tibia along with some friends. The Dr. said the damage was enough to make look parts of the tibia as a sponge. So, it is difficult to predict if the distraction will be succesful. Still I have nothing to lose by trying. Right now the only other alternative would be fusion, and even that has a failure risk for the same reason. Honestly I had whished for a better prognosis, but it is what it is. No gobble gobble for my this year, but I will keep fighting. Carlos

  3. Carlos,

    Good luck to you! Glad you found a place you're comfortable with. I know EXACTLY what you're going through.

    Make sure you put in the effort to set reasonable expectations for this procedure. Have low expectations but high hopes.

    I've started to notice the signs of returning arthritis since I've stopped using my crutches. The pain level is still not high enough to bother me, but I'm interested in seeing where it ends up in March or April next year.

    The greatest thing about this procedure is it doesn't burn any bridges -- the only downside is it uses up about 24 weeks (12 in the ex-fix and 12 to recover).

    If you can establish a good relationship with your doctor through this operation, that'll help down the line when it's time to treat it again.

    Keep me posted on how things go!

  4. Tony,

    I saw the doctor this morning and thought I'd give you a quick update. The knee is a totally different animal, I'm sure. But I think we can draw parallels since they both use the same method for the same result.

    First he gave me a shot of Supartz -- it's a common injection for knee arthritis made from rooster combs. It's said to normalize the joint's environment, and that is supposed to provide relief. I think of it as lubing up the joint. And the shot itself can provide enough relief that it can delay a knee replacement for up to 4 years.

    He then measured the joint space between my tibia and femur and found a 1mm increase. He said it's one of the best he's ever seen after three months. But he said he couldn't tell if it was cartilage regrowth without an MRI.

    But I'm still not feeling the relief I expected. He keeps telling me I have to wait six months till I start to feel happy that I did it. In my case that's February.

    I'm really enjoying tracking your progress. It's nice to know I'm not alone in electing this type of unconventional surgery.


  5. Tony,

    Thanks so much for taking some time to provide support and advice! I will certainly keep your words present. As you said, the time and energy required by this treatment is huge. I am trying to keep my mind on good vibe mode, and hopefully strong for the procedure and times ahead. For me at least, I am sure is going to be a long year, but better that than the alternatives if I can avoid them for now.

    Took a look at your pictures, and comparison of your ankle last year vs now show a substantial decrease in amount of swelling. Mine seem to be happy early in the morning when I wake up, but then gradually swells during the day, not big deal though.

    Paul, amazing how a different joint changes the scale of the procedure. For ankles, distraction usually targets 5-6 mm in the OR, and sometimes adds another 2 later. Apparently, longer values risk nerve damage as Tony mentioned before.


  6. Shoots of roster combs in your knee sounds really awesome! Carlos

  7. How are you doing these days, Tony? I can only hope that the lack of updating means that you're feeling really good and are off doing more exciting things than posting here... :)

    Merry Christmas!


  8. Please!!! Give us an update :D

    I have followed your blog for a while now and is heading the same way as you with the ankle distraction.

    Merry christmas

  9. I am sorry for your ankle! But every thing will be ok! Happy!

  10. That’s a pretty huge recovery progress! Your continuous physical therapy session will help you to recover, though not totally the same before your accident, but at least you can still walk and do tasks on your own. This must’ve been a big lesson for you. Hoping for your faster recovery!
    Penelope Bonnet @ U.S. Health Works Medical Group