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Old 04-17-2005, 12:11 PM   #1
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Transition from crutches to walking after surgery

Hi All!
I am 17 days post-op from a modified Brostrom procedure and arthroscopic debridement of the ankle for chronic instability. I went for my 10 day post-op last Monday, got the splint off and stiches off. My OS put me in a fiberglass cast until April 27. He told me I could "bear weight as tolerated". It's almost been a week and there is no way at all I can bear weight on my foot. Is this normal? I am still in pretty significant amount of pain, mainly over the lateral incision area. I'm still taking Darvocet for the pain, none of the over-the-counter medications help.

I was just wondering how long it took everybody to wean themselves from the crutches. My OS said that when the cast is off, I go into a walking boot, and start PT. I am hoping once I get into the boot I will be walking--they are alot easier to walk in than a cast. Will it look bad if I am still on crutches when I go back to my OS on 4/27? lol Also, for anyone who has had this procedure, how long did the pain last, and how long were you on narcotic pain medication?

Thanks,
Megan

 
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Old 04-17-2005, 03:45 PM   #2
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Re: Transition from crutches to walking after surgery

I also had the modified brostrom.
My OS had me NWB for 3 weeks. I remember at day 14 telling my wife: "there is no way I am going to be able to put weight on this thing in one week." I remember 3 days before being able to go PWB thinking, "wow this is going to hurt."

On day 21 I starting putting weight on it with the crutches and taking a few steps around the house. It took me a full five days to go full weight bearing. I rarely used crutches after that. I think you will be surprised how different you feel in a week or ten days from now.

You will find that throughout this ordeal that healing does not progress evenly. You may leap ahead only to fall back later. You will do too much one day and pay for it the next.

 
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Old 04-17-2005, 04:24 PM   #3
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Re: Transition from crutches to walking after surgery

I had the same procedure, but also had a repair of an osteochondral lesion... I was NWB for 5 weeks, and it took me almost 2 weeks to go to no crutches. At first I was supposed to go from no weight to full weight in only an aircast, but that was not working so I used a boot. At first I thought there was going to be no way, but I slowly went from just touching my toe to putting a little more weight on it, to doing a real "walking motion" wiht a little weight, to actual walking. You will probably have some tingling sensations when you first start, but they will go away quickly... i only used perscreption drugs for the first few days, maybe 5 or so... but I dont like taking meds and I have a high pain tollerance. I took advil for a while though, especially when I was up and about for a while. Good lucK!

 
Old 04-17-2005, 07:59 PM   #4
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Re: Transition from crutches to walking after surgery

I was NWB for 6 weeks after my surgery. I think I was on the heavy drugs for about two weeks maybe? After about 4 weeks I started just putting a little weight on it in the standing position (starting with little more than just resting it on the ground, then progressively just a little more). After you feel like you can put some weight on it standing, you can try the walking thing. It really slows you down when you try to walk with just putting a little bit of weight on it while still using the crutches, so don't expect to be able to go as fast as when you were NWB on crutches. Just take your time, though, and if it hurts, don't push it too hard.

After you feel pretty good on two crutches putting weight on it, you can go down to just one crutch. Use the single crutch on the side OPPOSITE of your surgery foot.

At 6 weeks when I got into the boot and the doc said I could start walking on it, I tried to put my full weight on it and just about fell over because it hurt so much. So I just spent some time putting a little weight on it every time I was standing around, then incorporating it into my walking with just a little weight. It only took me about three days to get to walking again, but this was 6 weeks after surgery and things were pretty well healed. I wasn't really in any pain anymore at that point.

So take it slow, listen to your body, and don't worry about what the doctor thinks if you go in there on your crutches. Just tell him that it hurts too much to put all of your weight on it, and he'll deal with it. Also, don't worry about starting PT while you are still on crutches. They will start you out with seated things anyway. The first few weeks of my PT I did soaking in hot water with electrical stimulation, then ultrasound, then massage, then stretching. The focus was mainly on getting the swelling down and increasing my range of motion. Strengthening came later, and a lot of the strength will come back just from walking, as you get back into that. But my point here is that they will still be able to start PT and work with you even if you are still on crutches.

Good luck.

 
Old 04-18-2005, 07:56 PM   #5
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Re: Transition from crutches to walking after surgery

Thanks for all of the walking tips!

I will be 3 weeks post-op Thursday. I am trying to put small amounts of weight on my foot, like when I am standing...instead of holding my cast leg up off the ground, I am putting it on the ground with a little bit of weight. That is really all I can do at this moment. The pain is still too great.

I've been having alot of pain over my incision. Is there any way that the incision could be opening up? I had my stiches out last week at 10 days post-op and all the nurse did to the incision was put some steri-strips over it. And to make things worse, I had to have the cast changed the next day because it was not padded enough, and fell crutching into the doctor's office, falling right onto the incision side of my cast. The pain in that area has gotten progressively worse since then. They x-rayed it at the doctor and I didn't do any bony damage, but could it have disrupted the incision?

Another thing I was wondering about is pain over the back side of the lateral malleolus, in the area of the peroneal tendon. Nothing that I know of was done to the tendon during the surgery, and I have been having a bunch of pain there. Who knows!

I am going to be trying really hard to be putting more weight on my foot this week...I can't wait to get this cast off and go back to the boot!!!

 
Old 04-19-2005, 08:40 AM   #6
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Re: Transition from crutches to walking after surgery

Megan:

I was able to go off the narcs and just take tylenol/aleve by about day 10 or 11, so my pain wasn't as bad as yours. When I did start putting weight on it - it did feel from time to time like someone was sticking an ice pick in the side of my ankle. It didn't really feel like the incision hurt, it was a bit deeper.

I have found that I have gotten (and still get) all sorts of pains. They aren't always in the same place. Sometimes they are dull sometimes they are very sharp. Sometimes they are in the front of my ankle sometimes in back. Sometimes on the lateral side sometimes on the medial side.

You likely didn't re-injure yourself when you fell. After the repair while you are still under your OS took your ankle and moved in all sorts of directions and pulled on it to make sure that the repair put everything back in the reight place and that the tightness is correct. So its not a real fragile repair and the cast provides a lot of protection. If you think about it you can't really turn your ankle in a way that would damage the ligaments.

As far as your incision pulling open: in August I had arthroscopic debridement and also a big incision (about 4") to remove some of the tibia (more was taken off during the brostrom also). The sutures were taken out at 8 days which was too early in that case (the wound was still oozing) and it ended up opening back up a few days later. In my case having the incision open back up didn't hurt. My guess is that the pain you are feeling is from where the ligaments were repaired.

Everyone has a different recovery and a different amount of pain. If it really still hurts then don't put weight on it. I think you should go at your own pace. I totally understand what it is like not being able to see the incision and wondering about what all the pains you are feel are attributable to. I was in a lot of pain on a daily basis before the surgery (due to subluxation) and I was really worried that he surgery wouldn't fix the pain (it did). The Modified Brostrom procedure has a very very high success rate (studies I have read are 85% - 90% "excellent" outcomes with most of the rest being "good" outcomes).

I really hope that it becomes less painful soon. Try not to stress about it. Let your body heal at its own rate. You'll get there.

 
Old 04-19-2005, 11:56 AM   #7
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Re: Transition from crutches to walking after surgery

You could call your doctor and ask about the pain. Is it the same kind of pain you had before you had your cast changed? I would just call the doc and let them decide whether you should wait until your next appointment or come in to get it checked out. My worry would be infection, since they had it out and were messing with it. Take your temperature to see if it is elevated. Most likely it is nothing, but I'm one of those worriers, so I called the doctor all the time to check on things and make sure they were normal. Much better to call and find out that everything is fine than to worry about it. Good luck.

 
Old 04-19-2005, 08:29 PM   #8
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Re: Transition from crutches to walking after surgery

I generally feel fine, my only complaint is the ankle pain, and I have no fever, so I don't think there is any infection in there. I have been trying to sit around with my leg elevated as much as possible to reduce swelling and pain. I think this cast could be the source of some of the pain I am having because it is loosening up alot. But I get it off next Wednesday...I think I can deal with it until then. I'll just continue taking my pain meds as necessary. I'm trying to taper them down a little, taking them only 2-3 times daily. That is a big improvement for me.

Has anyone noticed that the pain seems to get quite a bit worse when the surgery leg is hanging down and not elevated? Also, did everyone else's toes turn pretty shades of blue and purple when the foot was hanging down? (My toes turn a color of blue that almost matches my cast!) I haven't been able to drive since surgery because I can't sit with my foot down for so long, so my mom has been my chauffer (sp?), and it has been nice!

 
Old 04-19-2005, 09:08 PM   #9
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Re: Transition from crutches to walking after surgery

I never had too much problem hanging my leg down after the first few days and my toes never turned colors. I do know that others on this board have had this happen to them though.

 
Old 04-19-2005, 10:24 PM   #10
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Re: Transition from crutches to walking after surgery

I definitely had problems with that. I had pain when it hung down for several weeks. My toes turned pretty colors when I let my foot hang down for at least 4-5 weeks. I think it got better after I started walking. It is completely normal, though... Just keep it elevated whenever you are sitting down.

 
Old 04-20-2005, 01:01 AM   #11
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Re: Transition from crutches to walking after surgery

I have a lot of pain as well. Difference is I didn't have surgery--I was in a cast and then walking boot. But the pain is mostly in the back of my heel and it hurts a lot to walk, especially when going down the stairs. I've weaned myself off crutches and the boot and into regular shoes starting last Wednesday. It's almost been a week and I still walk with a limp and am in a lot of pain. When does it get better? This healing process has been taking so long and my life has almost been put on hold because I don't know how I'll be if I decide to take a trip in a few months,etc.

 
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