I have seen several people talk about their post surgery physical therapy and I was wondering what people were told to do.
The only therapy that I have been given to do is to flex my great toe back and forth and try to increase the range of motion. Doctor's goal is to have my toe flex over 100 degrees so I am supposed to push pretty hard on it. It doesn't hurt too bad to do this, but it is a bit uncomfortable. Right now I am up to about 90 degrees, that last bit seems unlikely.
Are other people doing different therapy?
Thanks
Mac

I have been told to massage the scar often with vitamin E oil or mederma or something like Eucarin cream often, which helps the scar to become more pliable. You are also supposed to desensitize the scar, by rubbing it with a rough towel or something similar. As far as range of motion, I've also bent the toe area back and forth. I am now trying to curl my toes around a rolled up towel and when I am in the pool I am trying to put more weight on my foot and practice standing on my toes. Last week the physical therapist had me put all my weight on my postop foot, while I stood on a foam pillow. I have to say this hurt alot and the rest of the day my foot ached. Now, 9 weeks post op, I'm always bending my toe and flexing my foot and I'm gradually trying to stand on my tiptoes. Another thing is try to "write" the alphabet out with your big toe. My arch hurts alot, so, I use a tennis ball to massage the arch. While I sit down, I roll the tennis ball back and forth under my arch and up to the toes. My PT use some electrical stimualtion, but I don't know if that really does anything. I'm also carefully practicing walking more aggressively on my foot, to gain my balance again, though this can cause my weak foot to swell still. My PT still says I should ice and elevate, and, that using the ellipitical is okay now. I swim, so, that has been good therapy for me. I also do foot exercises, while my foot soaks in hot water. Hope this helps. I'm still at the frustrating stage and am just glad when I can walk evenly for a few hours.... Compared to 2 weeks ago, I'd say my incision area is less stiff, with the PT, especially with the regular massage, but, progress is slow.

Thanks for the information, that is very helpful, how long were you NWB and PWB?

I was NWB for the first 2 weeks and I was PWB up to the 6th week. That said, I was still off my feet 80% of the time the first 6 weeks, and I was icing and elevating when I rested. While I was PWB, in the soft cast boot, for 4 weeks, I mainly ran quick errands...nothing strenuous...and I limped....struggled.... My foot swelled and ached. At the 5th week mark, my incision area on my left foot finally closed over, and, I baptized myself, in the pool, early in the 6th week, for a feeble attempt at swimming laps. I'm amazed, as a regular runner, how quickly you can get out of shape. When I started wearing wide shoes, at 6 weeks, I felt week. Now, at 10 weeks, I feel more steady on my feet, but, my foot still aches and swells, though I'm not limping anymore. The regular massaging of the scar tissue and the bending of the toe area and the foot flexing gradually helps ease the stiffness. At 10 weeks, my toe is less stiff, but I have a ways to go. The only shoes that are working for me are my wide hiking boots or some wide TEVAs, sort of like Crocs. Anything rubbing up against the incision hurts, which is why desensitizing the scar tissue is important. I'm hoping at 12 weeks I'll feel stronger. Also, at 8 weeks, I gained confidence that when bending my toe area, I wouldn't break the fusing bone. Before 8 weeks, I was nervous about moving the toe, though I gingerly moved it from 3 weeks on...When did you have your surgery? Patience plays a big role in this, and, as a runner, I'm facing the uphill challenge of rehab, and some depression in not being able to run. I just started PT, at the 8 week mark, so, I'll be happy to let you know what else I learn. I hope to be runnning again, by the summer. Hope this helps, because others have helped me on this board too.

Hi Runnermac,

I did a lot of the same PT exercises as wmkcolors mentioned. I was NWB for 6 weeks and started PT around the 8 week mark.

In addition to bending your toe back and forth several times a day, I would do the alphabet, towel scrunches and tennis ball thing that wmkcolors suggested. I also had to pick up marbles with my toes and put them in a plastic container (about 30 or 40 marbles, 3 x a day). If you were NWB and your leg muscles atrophied, you can get a resistance band and put it under your foot and hold it tight near your knees and do leg raises while sitting down in order to strengthen your calf. Have you heard of a bosu ball? It's kind of like those ab exercise balls but cut in half (most gyms have them), you stand on it with your surgery foot while lifting your good foot up and balance for 30-60 seconds at a time.

If you're ready, you can also do toe raises on just your surgery foot and the leg press machine at your gym. If you have one that allows you to lie down completely horizontal, you can use your bad foot and push off it as if you're jumping in the air and catch yourself only with your bad foot. This helps strengthen all of your leg muscles.

Those are the easiest ones to describe. If you're doctor has not suggested seeing a physical therapist at least once or twice, I would ask him/her about it. Also, like wmkcolors said, cocoa butter and vitamin e work great for minimizing scars. And make sure to massage the scars well to remove any scar tissue underneath the skin.

Dancergal, were you in much pain, at the 9-10 week mark, as you became FWB and were doing PT? I'm concerned about how much my foot aches at this 21/2 month mark, as I thought I'd be more healed or stronger by now. Maybe that's unrealistic....when were you pain free, while walking FWB, for long periods? Within an hour of FWB, my foot aches alot. Thanks...and all the best to Runnermac, on your PT.

My 1st surgery was about 3 years ago so my memory of exactly when things quit hurting are a little blurry(probably why I am having the the other foot done) but I think I was FWB about 2 mos before things were pretty good. I kept my boot/cam walker handy for at least 3 weeks after I started wearing a shoe. I remember going hiking about 2 months after the surgery and 1 1/2 miles about killed me(I can normally hike 7 to 8 miles no problem). I couldn't believe how long it took for things to really get better, I thought "foot surgery, not problem" ...little did I know and the Dr didn't really clue me in to what I was in for.;)

In the long run it was worth it, but there were times I figured I must have been out of my mind for agreeing to do this(I am sure I will get there this time too). The foot I had done does not bother me hardly ever now. And this foot seem to be going better than the first. I am not looking forward the 1st month back on my feet other than getting it over with:blob_fire

Saw the doctor yesterday and he really crunched my great toe back as far as he could. Rather painful. He wants me to get about 110 degrees of flexion in it and push beyond that if I can. I don't know as my toe every flexed that much to begin with. Right now he can get it to go a bit over 90.
Anyhow I am now supposed to flex the toe back and forth through mild pain for 1000 repeats. Seems a bit extreme but I am determined to be able to run as well as pre-surgery so will suck it up.
Thanks to all who replied about your own PT, I can't do any of the full foot ones yet as I still have pins in my 2 & 3 toes (dislocations) for 2 more weeks. But once at that point I will put your suggestions into practice. Right now I am happy enough because I was able to pedal a recumbent bike using heel pressure for 45 minutes today. At least I will maintain a bit of fitness this way.

sounds like you have a reat dr and wants to see you up and running. i also now can do the bike with heel pressure and sit and do upper body. that part is great. good luck with therapy its a lot of work.

wmkcolors - sorry for not responding sooner.. Yes, I was still in pain at the 9-10 week mark. I felt general discomfort after periods of walking and it hurt a lot when the physical therapist was manipulating my foot. Slowly, the pain became on and off and I'd say I didn't feel much pain around the 4 month mark. I still had occasional foot pains for a few months after that, but they were very mild. I also have a pretty high tolerance for pain, I think. I never felt major discomfort after the surgery, it was always just uncomfortable and achy. I think it's totally normal for you to still experience some pain and I think the PT will contribute to that, but thats normal as well. Your foot is still healing so just take everything in stride. I'm sure in a few weeks you will be feeling MUCH better and will be back to exercising before you know it :) The time frame for everyone is different, so don't stress about it. Just take it all as it comes and enjoy the fact that you're no longer on crutches!

My 1st surgery was about 3 years ago so my memory of exactly when things quit hurting are a little blurry(probably why I am having the the other foot done) but I think I was FWB about 2 mos before things were pretty good. I kept my boot/cam walker handy for at least 3 weeks after I started wearing a shoe. I remember going hiking about 2 months after the surgery and 1 1/2 miles about killed me(I can normally hike 7 to 8 miles no problem). I couldn't believe how long it took for things to really get better, I thought "foot surgery, not problem" ...little did I know and the Dr didn't really clue me in to what I was in for.;)

In the long run it was worth it, but there were times I figured I must have been out of my mind for agreeing to do this(I am sure I will get there this time too). The foot I had done does not bother me hardly ever now. And this foot seem to be going better than the first. I am not looking forward the 1st month back on my feet other than getting it over with:blob_fire
It sounds you have more lucky than some of us. I had a spur removed on my big toe. I bothered me when I used some shoes, but I was able to walk on mountains for 3 hours without pain. The doctor promised me it was simple and I could wear my pretty working shoes without a pain for no less than ten years. It has been four months since the surgery and now I can not walk one step without severe continous pain. The surgeon is ignoring me and told me I may just have arthritis and he could do another surgery. He is not taking responsibility and release from his care like I am perfect now. I feel frustrated, depressed as I cannot wear any shoes only the orthopedic one and with pain. If I would know this or if he would explain to me this results I will never had that surgery. His promise was a lied to get money.
I wish I have the hope to get better not worse.

It's good to know that I am not the only one at 9 weeks that is still having pain and stiffness issues. If I bring it up to my doc all she says is "Oh...but it is only (#) of weeks." And then "You have to push yourself....push past the pain." Yeah. Right. Still stiff, still having pain issues regardless of what I do or don't do.

Did any of you have your doctor give you a velcro splint to wear to hold your big toe straight?
I have been wearing one at night and was wearing it full time while I was in my boots and wondered how effective it is. Doc says that it is to keep the ligaments from goiing back to their old position, pulling on the big toe like they used to.

I didn't have one...but as I've been watching my healing process (and something I have asked my doctor but won't get an answer to until Wednesday), I've noticed that when I bend my toe up it pulls to the left. The good toe pulls straight up. So, I'm wondering if maybe I should have been wearing a bunion splint before the bone healed completely so as to help everything stay in the *new* place instead of migrating back to what it was.

RunnerMac - I was given a bunion splint as well. My Pod said you have to 'train' the tendons to pull the big toe away from the other toes. I think it helps to a certain extent. I wear a small one during the day inside my shoes and wear a stronger one at night while i'm sleeping. I don't know if my big toe will ever be straight, I think the tendons are too stretched out from 24 years of having a severe bunion. But I think the splint may help prevent it from getting worse or from having the bunion come back. There is a magazine called Foot Smart that has a lot of great products for bunions.

Did any of you have your doctor give you a velcro splint to wear to hold your big toe straight?


Hey RunnerMac,
I wore that last time, too, and started wearing one for foot #2 last Tuesday. It seems to have worked for me on the first foot. I wore it from week two (starting around April 11 or so) until about the end of July. I MAY have worn it a bit longer than she said I could stop because I was paranoid and just plain used to it. I felt so weird to go to bed without it. Actually I wore it day and night until about June, then night only for most of the rest of the summer. I'm pretty happy with how straight my toe is. It's not perfect but considering where it came from, I'm pleased.

Thanks all, I will have more faith in it then. I often get tired of it at night as it can feel like it is so tight on the toe. During the day I wear toe spacers to take its place and they aren't much fun either. My already wide foot gets a bit wider!

wmkcolors-
I am walking more, I did an hour on forest trails on Sunday and felt good. The only thing holding me back now is that my toes are still stiff when I extend my stride. That is a slowly improving factor that I need to work on.
Swimming seems to be really good for that as it is a constant flexing motion the whole time I am in the water with no weight on it.
The swelling really improved after the first week in shoes, I am now in the second week of that and unless I am standing for a large part of the day there isn't very much swelling at all. I am still icing at night and have my feet up on my desk whenever I'm not busy with students, but it is more preventive than anything else.
I hope your ROM improves significantly now that you worked past that initial point, I know what you mean about trusting your feet again. I am just getting past that point myself at 12 weeks post-op.

So Ms Tammy your toe is not totally straight? When my doc took the dressing off the first (and so far only ) time I saw my bare toe for the first time since the surgery and it still has a bend to it and looks funny. My doc reminded me of how bent and twisted it had been. I was just wondering about if anyone else had a toe that was not perfectly straight. Sounds like that is the case for you?

It's just oh-so-slightly off. When my foot is flat on the floor, it's straight and fine and loks perfectly normal. When I lift it up, though, it does lean a teensy bit over. Not bad at all. It's not something where someone would say "oh, look at that crooked toe!" It's just something I notice.

My big toe is also slightly crooked after the surgery. I was really terrified until I 1) looked at my non-operated toe and realized just how much improvement here was and 2) realized that many "normal" feet have big toes that bend in slightly. As long as it doesn't move under the second toe again, I'll stay happy.

Post bunionectomy (great toe second toe osteotomys) I had PT.
I did a bunch of things BUT the most important was learning how to flex and stretch the toes. Two and three years post op for both feet, I still do the stretchs on the toes every single morning. The toes are stiff in the morning and this helps me mucho.
How to do that properly was the most valuable thing that I learned !

I agree Cosmic, doing PT and learning how to stretch and bend the toe and regain ROM is sooooo important. At almost 4 months postop, I'm pretty stiff, especially in the morning, but I work through what sort of feels like arthritic pain to achieve a better stretch. I do something every hour and as time passes and I'm trusting the bone healing more, I'm trying to be more aggressive with the stretching. This is something you do have to work through and even force, to retrain the foot.