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Old 07-28-2008, 04:22 AM   #1
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Calcaneus fracture - help-what is happening now?

I fractured heel on 28/2/08, no surgery, NWB 12 weeks then partial WB as tolerated for 6 weeks and then told to WB on crutches as tolerated and continue PT and progress from there.
Last week foot felt so great that I went out with 2 crutches for first time ( in wheelchair outside before then) I then started to use 1 crutch inside and even short attempts at no crutches although was limping more than walking.No pain until this week and now have had to go back to 2 crutches as foot very painful even under heel foot part.

Am I trying to go too quickly or this normal progression pain? I am a normally active 61 yr. old female.

 
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Old 07-28-2008, 07:30 PM   #2
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Re: Calcaneus fracture - help-what is happening now?

patw27,

I'm sorry your hurting, but it sounds like your going to fast. When I started walking witht he two crutches I put maybe 10% of my weight on the hurt foot. I gradually increased the weight I did that for about 2 weeks, during the 3rd week I used both crutches but I started to venture small distances with only one crutche. For example if I was at work I would go to the ladies room using only one crutch but I used both to go in and out of the building. After the 3rd week I used one crutch but I was only putting maybe 60%-70% of my weight on it and I was going very slow. That's how I did it, I don't recall it hurting me much but at that time I was very scared to put weight on my foot so I was very cautious. Take you time don't rush it, while your using the crutches concentrate on making your foot make all the right moves during it's step. That's the one thing that I wish I had taken my time with more than I did. Once I got rid of both crutches I started limping and eventually my knee started hurting and I had to stop and slow down and concentrate on my step. I wish I could tell you that was the only time I had to stop and reevaluate how I was taking my step but as you know I had to do it again just a few days ago! Hopefully tchair replys to your post he was the one who told me how often and how much weight to increase as I was using the crutches, I can't remember what he told me. The only thing I do remember is that he told me to start with just 10% of my weight.

Hope you feel better soon. Keep in touch.

Caroline
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Old 07-29-2008, 02:04 AM   #3
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Re: Calcaneus fracture - help-what is happening now?

Thanks Caroline,
I think I probably did do too much too soon but my foot felt so much better that I thought I had turned the corner, I think I should have stayed on 2 crutches for longer.
Went to PT hydro therapy pool for first time yesterday, did walking on toes, walking on heels, stepping up and down, balancing on injured foot. I could hardly walk this morning without taking pain killers before leaving bedroom. Not a lot of swelling but pain around heel and ankles, is this normal?. The worst thing about this injury is worrying about doing more damage, I can stick the pain if I know that everything is normal development.

Thanks again

Pat

 
Old 07-29-2008, 07:17 AM   #4
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Re: Calcaneus fracture - help-what is happening now?

Pat,

Yes itís the normal progression. You've been mostly off that foot for four months, that alone will make it uncooperative when you try to use it. Even without an injury, joints get tight, tendons shrink, muscles wither and circulation diminishes. And as they say on TV: "But wait, there's more!" Your motor nerves are out of practice and sensory nerves are accustomed to very little stimulus. The recovery curve is very steep at first. The usual progression is to have large and frequent setbacks at first, then less so as the weeks go by. But setbacks are a sign that you are doing what's needed to make progress. You do want to stick with it, like climbing a mountain you take a breather then keep going.

There's nothing better than hydrotherapy. You don't need to be actually walking to gain back your physical capacities. Many use therabands your joint motion, do leg lifts for muscle tone and circulation and aerobics for stamina. The happy medium would be to some work while weight bearing and supplement that with NWB exercises.

I have never seen a Heelie incur further injury by over doing it. It seems to be self limiting. The only thing even close that I've heard of (and it is quite common) is like Caroline, being in a hurry, favoring the foot to go fast then making the leg muscles and joints ache. In that case it is time to slow down and remember to keep working on the foot.

There are two suggestions I'd make: Stay ahead of the pain. If you know you'll need the meds take them a little in advance rather than trying to play catch-up. Also, take actual notes of your progress. It will help you appreciate advances that you make and serve as a reminder and record of any issues that you discuss with your doctor. While the pain in your heel (and yes ankle) sound like the usual you will want to keep your doc apprised at your next follow up, and with an injury like this don't hesitate to call rather than ignoring a problem or worrying needlessly.

I've read that this injury is most common in males aged 45 to 50 years and that older people have a harder time recovering. My personal observations have been that an equal number of women are joining the club (probably indicative of who actually really does all the work), 20 year olds are quickly joining, admitting alcohol as a factor, but most importantly that those over 60 are fairing as well or better than the others.

TC

 
Old 07-29-2008, 12:47 PM   #5
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Re: Calcaneus fracture - help-what is happening now?

Thanks tchair,
I am going to take it easier but still exercise and hopefully things will improve. It was just that after last week's improvements I was shocked at how quickly I started to hurt again.I expected to be sore today after the pool.

I was really annoyed yesterday when someone told me ( an x- nurse - not in Orthos) that if I had had operation it would have been 3 days as inpatient then walking without limp a few weeks later, what does she know????

I will keep you posted as I appreciate everyone's help

Pat

 
Old 07-30-2008, 02:37 PM   #6
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Re: Calcaneus fracture - help-what is happening now?

Hello Pat,

Am one of those 'over 60-yr-old women' (65 actually) who broke a heel, had surgery, was not allowed to bear weight or move the foot at all for 16 wks. The weak, no memory foot tchair described is quite accurate in my case. I couldn't even 'remember' how to stand balanced on two feet after all those weeks of training the brain and muscles to stand on only one ....

When I finally got permission to try to walk, the first week or two were the roughest. The walking gear was weak, shortened and had forgotten just about everything. I lucked up by finding an excellent therapist who demonstrated, made me practice, a 'three-step' with proper gait. That's all we did, that first session, and it was the sole assignment for that week at home.

The therapist told me to stand on a hard floor in sock feet (so I could see as well as feel what the feet were doing), balance with each hand on something steady (I used the kitchen counter on one side, cane on the other), and practice that three-step exercise over and over again. He told me to lead with the injured foot, then step out with the other, then stop when the injured foot made its second foot plant. That was all there was to it.

Doing it hurt a lot at first, so I kept the sessions short and did them several times a day. Inbetween, I elevated and iced the foot frequently.

After about two days of practicing, could walk around the house slowly and painfully with a cane, but in proper gait. While 'walking' (sort of), I wore Nike Airs, which was a nice cushion. A couple more days and I needed no aids. But the foot still complained a lot. By week three, things got better, and progress went on from there, with more and more comfort each day.

All those muscles, ligaments, tendons needed to learn to do work again, and it took a little bit of time to persuade them.

Here are a few things that helped along the way:

1) Stretch your achilles tendon and calf muscles (soleus and gastrocnemius) GENTLY but frequently. If you can manage it, stretch all the other walking parts (hamstrings, quads, ITB, etc).

2) If the underside of your arch area (plantar fascii) is tight and painful, try rolling it back and forth on a large rolling pin. This exercise completely wiped plantar pain in about three days during the first part of my rehab.

3) Try some calf raises. Most likely you'll have to start by doing them balanced on two feet. You can then work your way up to doing raises on a single foot.

4) Give your leg muscles some work to do, too -- isometrics for the quads helps get the knee working again, leg lifts for the quads, hamstrings, hips (adductors/abductors) are beneficial, too -- it's all out of practice. You can do this kind of stuff without bearing weight.

5) After any work session, elevate and ice your foot-- this helps it recover from the work, reduces swelling, increases comfort level.

6) An infra red heating panel improved everything for me. Infra red heat penetrates deeply into the foot, improves circulation while I couldn't walk very much to do that. Improved circulation carries off debris, reduces swelling, reduces pain, and promotes soft tissue healing. It's the biggest something for nothing I've ever run across, and I used it more than once a day for a long time.

I dunno, Pat, seems to me that a lot of short sessions doing all this stuff -- practicing proper gait, strength building for the hips, upper legs, calves and foot, stretching -- worked better for me than one or two longer sessions during those first few weeks. At least that was my experience.

The catch 22 about rehabilitating a recovering heel seems to be that to improve circulation and to strengthen the walking gear, all of which promotes soft tissue healing, reduces pain, and decreases swelling, what works best is walking itself! But at first we can't do much of it, so we have to think our way around it, find some shortcuts and eventually we can get there.

When you can walk more comfortably, you'll be able to do a lot more of it, and your foot will become stronger more quickly -- you'll be on your way, and and your foot will complain less by the day ....

I sure do wish you well in your recovery -- try to hang in there -- a few weeks can make all the difference ....

Take care -- Nell

 
Old 07-31-2008, 01:40 PM   #7
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Re: Calcaneus fracture - help-what is happening now?

Thanks Nell,
I will try the 3 step and rolling pin exercises. I felt I was doing so well 2 weeks ago and now the foot hurts as much as it did when i started to wb first, probably too much too soon.
I will also ice more, although I elevate I don't have a lot of swelling so I haven't been iceing which is probably a bad move.I did have a lot of swelling and pain after hydrotherapy, I wish my PT had reassured me that it is normal, I will be asking her next Monday on next session.
I do try to move my leg around a lot when I am sitting down, back and for and round clockwise and anticlockwise and there is a lot of clicking, is this normal?
How long were you before you could walk outside without any aids? Did you wear an aircast? maybe I should ask about one at PT.

Thanks again,
will keep in touch
Pat

 
Old 08-01-2008, 12:35 AM   #8
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Re: Calcaneus fracture - help-what is happening now?

'How long were you before you could walk outside without any aids? Did you wear an aircast? maybe I should ask about one at PT.'
======================================== ===============
Hi Pat,

RE: WALKING OUTSIDE UNAIDED
If memory is accurate, walking outside unaided began at the end of the second week of walking again. I wore Nike Air running shoes. I live in the boonies, have light, outside, twice-daily chores, which I decided could be part of the rehab. At first I took a cane along for balance, but didn't use it on the ground.

At the time, was concentrating totally on taking each step properly. So what should have been a half hour episode took much longer -- about an hour and a half, but it was worth it. Afterwards, I'd come in and ice.

For some reason, from the beginning, ground surfaces (even/uneven, grass, gravel, etc) made little difference. Back then, the foot hurt anyway with every step, but generally no worse because of the ground surface.

The concrete walkway out front did make the foot complain louder for a while. And when walking laps round the yards here (1 lap = 1/8 mile), going uphill, which required a strong pushoff, was somewhat difficult at first.

A couple of weeks or so working with the chores/laps made a big difference pretty quick. Seems like once I got to the place where I could walk more, even uncomfortably, the gains came faster and easier.

RE: POSTURE
Assuming upright posture (shoulders back, pretend a string is pulling the crown of the head upward) and remembering arm swing and hip movement upped the comfort level, too -- these things somehow 'lighten' the step. Tilting the head down puts more weight on the feet during the entire walking sequence, lifting it takes some weight off. Arm swings/hip movement assist the legs/feet, improve overall balance, quicken the step and thus reduce the time that weight is static on any one part of the foot.

RE: CLICKING
I don't know about the clicking you describe. Maybe tchair does, and for sure your doctor will. Sometimes shortened muscles, tendons or ligaments can temporarily cause clicking. I experienced this some years ago during broken kneecap recovery.

RE: ICING
As for the icing, the foot here had very little swelling. Not being able to move the foot for several weeks signals the body to take certain measures -- it produces joint effusion -- more or less fluid/swelling. I think the medical community calls this phenomenon a 'dependency.'

Fortunately, as you described in your case, my foot had the minimum, could barely see it, but when present, it made quite a difference in the comfort level. Icing left the foot effusion-free for some hours, and walking comfort was much better then.

RE: TIME FRAMES
After recovering from both knee and heel injuries, it seems to me that the heel recovery was much more complicated. But definitely possible, thank goodness! Strengthening, stretching the walking gear without weightbearing and walking only a little at first turned into just walking eventually. For sure, every heel break is different, and each person's recovery journey has its own time frame. More or less time doesn't matter as much as the end result.

Here's hoping your journey is comfortable and smooth, Pat.

Best wishes -- Nell

 
Old 08-01-2008, 04:35 AM   #9
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Re: Calcaneus fracture - help-what is happening now?

Thanks Nell,
I seem to be taking longer than you, already 5 months and cannot walk without crutches but this could be because I did not have surgery.
I have been using rolling pin and theraband exercises this morning and icing and foot seems easier.

Speak soon

Pat

 
Old 08-01-2008, 09:49 AM   #10
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Re: Calcaneus fracture - help-what is happening now?

Hello again, Pat,

RE: TIME FRAME
Time frames are usually different for each person. Mine wasn't necessarily brief -- it took a while to resume normal activities in comfort, but am grateful for the recovery of course.

RE: ROLLING PIN
When you use the rolling pin, try to increase the pressure on the bottom of the foot as you progress. This can be painful at first, but soon it won't be -- that's when you'll know you've made a step up.

RE: ICING
Tchair advised to 'keep on top of' managing pain -- i.e., attempt to not let it get going very far by medicating ahead of time. I have no experience with this because pain pills produced extreme nausea, but think it's great advice.

You can try the same scenario with icing for the swelling -- try not to let it get ahead of you if you can. In my situation, the smallest amount of effusion usually meant more discomfort (mostly ankle pain) bearing weight. Of course, immediately after icing, the nerve system can't report pain as well, but the icing effect here, which reduced that small amount of joint effusion, lasted for some hours and made walking easier.

The strategy here was to do whatever possible to increase comfort while weightbearing. The less it hurt, the more I'd walk, which seemed to be the fastest route to better circulation/foot strength and resulted in even more weightbearing comfort. But I had to begin (about two weeks worth) with lots more time spent on nonweightbearing strengthening/stretching exercises than actual walking. As time passed, the weightbearing ratio increased.

RE: SETBACKS (MORE SWELLING)
If you experience a lot of swelling from some activity, you might want to try performing only the nonweightbearing stretch and strengthening exercises while giving the weightbearing stuff a brief recovery period. Over time, you'll figure out what works best in your situation, am sure.

RE: TRYING A WALKER
Do you have a walker? I had one stored in the basement (from the kneecap recovery days), tried it, decided that the floor surfaces on the second floor of this house (3 stories) where I recovered weren't that suitable -- a mix of tile, linoleum and carpet, so didn't use it much for walking even in the early days. It did turn out to be useful, when locked, for balancing while doing calf raises.

Depending on your own floor surfaces, a walker might be helpful for starters. I had difficulty using crutches because I never could figure out how to let down enough weight with their support underarm. Am sure most anyone could do it, but not me -- I was always wishing I could let down more weight after I'd progressed a bit.

That's when a cane came in handy. When using it, I could control exactly how much weight went down. Also, could practice proper gait better because using it allowed arm swinging and a chance to improve walking's more subtle balance requirements. Even after outside walking began for those chores/laps, I carried it in one hand to use for adjusting balance when moments surprised me ....

Of course, this cane is very special. It belonged to my mother, who used it through hip replacement in her late 80s and until she passed away in her 90s. Using it made kneecap recovery a breeze, so for this recovery, it was already an old friend ....

Am so glad you're one of the lucky ones who starts out with minimal swelling, that's terrific. I hope today is a good one at your house.

Best wishes -- Nell
======================================== =================


Quote:
Originally Posted by patw27 View Post
Thanks Nell,
I seem to be taking longer than you, already 5 months and cannot walk without crutches but this could be because I did not have surgery.
I have been using rolling pin and theraband exercises this morning and icing and foot seems easier.

Speak soon

Pat

 
Old 08-01-2008, 12:36 PM   #11
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Re: Calcaneus fracture - help-what is happening now?

Quote:
Originally Posted by patw27 View Post
Thanks Nell,
I seem to be taking longer than you, already 5 months and cannot walk without crutches but this could be because I did not have surgery.

Pat


Pat,

Don't compare. Every extra week of non-weight bearing and every week without some PT makes the first attempts harder. You and your doc were on the side of caution for healing so that got you off to a slow start. Don't think that another person went quicker changes that from being a wise decision. The alternative would have been to gamble and possible have serious setbacks. So long as you can see some improvement each week, you update your doc, he is satisfied and gives satisfactory answers don't worry about the pace. Even for those who get going the quickest it seems to take far too long.

Having surgery does give the doc an opportunity to tweak things, but it usually means the amount of damage - such as serious joint involvement - made it a necessity, plus it can open up a whole range of complications.

Clicking, like dozens of new sensations you'll experience, is normal and generally just goes away. Note it down, do ask about it and keep your doc appraised, but don't sweat it. And FYI the initial surgery is strictly for the bones and joints, not tendons, nerves or other.

Here's a bit of info:

The Peroneal Tendons are what pull your forefoot down (lifting you) and raise the outside of your foot in balancing you. They come from a calf muscle, run down the outside of your ankle to the calcaneus then wrap around the outside and bottom of the foot. Since this is not a straight line they are secured in an groove in the bone a and a ligament over them so they can pull 'around a corner' so to speak. When pulled taught, if one or both jump out of position then back they make a clicking sound. The medical term is "Peroneal Tendon Subluxation", has a nice ring to it.

The classic cause is ankle sprain, and the remedy is to let it rest for several weeks.
A calcaneus fracture likely includes a severe ankle sprain but you've already been off the foot for an extended period. While that time was good for healing ( as Nell stated) it was probably so long that the tendon shrank up some and making it want to pop out of place. A lot of heelies report the same sounds when they start using the foot, until the length and motion of the tendon improve. The injury would have changed the shape, angle and flexibility of the heel making a less than optimal path for the tendon so sometimes it's more or less permanent. I'm one of those who have had it continue, though it has neither gotten worse nor caused problems. A few who had surgery experienced pain as well and were told that it was scar tissue to blame, a couple having surgery to try to remedy it. Worst case scenario would be tears that didn't mend. That would involve complicated surgery and more down time. From what I've read, the pain level, tenderness and localized swelling would be a give away to that.

TC

 
Old 08-03-2008, 09:22 AM   #12
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Smile Re: Calcaneus fracture - help-what is happening now?

Thanks Nell and TChair,
Used rolling pin for last 2 days but yesterday was really bad day with foot painful enough to take me to my bed but today is better.
I have started to ice again although I do not have enormous swelling, my outer ankle was like a golf ball the dy after hydrotherapy but I am going for another session tomorrow ( no pain no gain).
I did use a walker for my 12 weeks weight bearing as I couldn't use crutches but am now able to use elbow crutches, mostly 2 but sometimes 1 crutch although that can be painful.The fortunate thing is that my 87 year old mother lives with us and she has several walkers that I was able to use.
The clicking seems to have mostly disappeared now so I think that must have also been after hydrotherapy.
I am going to start back to work at the end of this month as my team are great and I am sure that I will feel better surrounded by them and it will take my mind off things, I have been assured that if I find things too much I can work from home when necessary.

Thanks again,
keep in touch
Pat

 
Old 08-07-2008, 03:33 PM   #13
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Re: Calcaneus fracture - help-what is happening now?

Hi Heelies,
Just to let others know, I am now 51/2 months post fracture and have had ups and downs and felt that there would be no improvement.

I am pleased to say that ( fingers crossed) there seems to be more improvement this week.

The cracking and pain I had following my first hydrotherapy exercise has gone and I have had another 2 sessions and am now able to walk with only 1 crutch and sometimes walk a few yards without, slowly and limpy.

I still have pain and have to ice but definitely feeling better, so hang in there all you other heelies, it does get better

Pat

 
Old 08-07-2008, 08:30 PM   #14
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Re: Calcaneus fracture - help-what is happening now?

Hi Pat,
I'm really glad your feeling better!

Take Care!

Carole

 
Old 08-07-2008, 11:01 PM   #15
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Re: Calcaneus fracture - help-what is happening now?

'I am pleased to say that ( fingers crossed) there seems to be more improvement this week.'

======================================== ==================

Thank you so much, Pat, for this report -- it made me smile really big. Am so very glad that you are on your way! Congrats, of course!

Best wishes, take care -- Nell

 
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