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  • 2 1/2 weeks after PTTD Surgery

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    Old 08-30-2008, 05:43 AM   #1
    smile2006
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    2 1/2 weeks after PTTD Surgery

    Hello all-

    I am now 2 1/2 weeks post surgery for a torn posterior tibial tendon. I had tendon transfer, Dwyer osteotomy and debridement done. I wanted to post an update after seeing the doctor yesterday since I have handled recovery a bit unconventionally choosing to return to my job (University professor) after 8 days. I had a splint/ace bandage for 5 days, a hard non-walking cast for 11 days and yesterday was placed in a walking cast for the next three weeks. An arch was shaped into the bottom of the cast. The cast comes all the way under my toes although my toes are exposed from a top view. There is a thick soled "rocker" bottom ankle height bootie that velcros on over the cast. It actually feels like my foot has good flat support unlike the other cast that could not be placed (rested) down on the ground. My staples were removed from the three incisions. Removing the three in the heel really smarted but those on the inner and outer ankle just pinched a tiny bit. My foot was manipulated a bit to get it into an approximately 90 degree angle, or at least close. The angle is about 3 degrees off for what would be considered ideal but my ankle/foot flexibility was considered excellent for this point in time. I did alot of leg (hamstring and quad) flexibility exercises sitting on the ground plus wiggling of my toes and flexing of the foot as much as possible in the first cast which they told me to do to keep the blood flowing to that area. Being able to get the foot comfortably into walking position in the cast is critical to move to the walking cast I was told.

    My foot is still puffy but there was no bruising which was good to see. The incisions are better than last time but I'm still shocked at the medial incision which is probably 6 inches. I was told to gradually start to bare weight "crutch walking" and that by the end of the three weeks I should be walking on this walking cast crutch free. Right now I know I can't walk unaided because it is too painful, however, I can place some weight on it and being able to "crutch walk" makes mobility much easier. I am now able to stand and rest my foot comfortably on the ground because the cast/bootie combo make a nice flat surface. This will make teaching while standing easier and being able to walk a bit in the classroom will also be helpful when teaching. My foot did swell a bit from "walking" yesterday but I iced and it feel better this morning. When attempting to place weight on it the primary part of the foot that feels really weird (feels tight and tingles) is the tendon area. I was told that gradual weight baring should increase blood flow in the area of the tendon, stretch it some and help it heal. I was told to recognize the difference between discomfort and pain. To get things working again in the foot, there will be discomfort to work through. I was able to put a little more weight on it this morning I beleive. I am glad for additional mobility and was able to make dinner yesterday, walk the drive get the mail and walk through grass and into my garden and clip some dead flowers, I have missed being able to move about outside. At my next appointment my Dr. will re-evaluate and I will either stay in a cast or move to a walking boot. I will also start some PT at that point if I move out of the cast. That next appointment will be just a few days short of six weeks. I highly trust my Orthopaedic surgeon and the path he has taken. He works with athletes from a major univeristy and he and I both know my goal is to be able to run again pain free. I hope this update helps anyone trying to navigate their decision to do PTTD surgery while at the same time highlighting my experiences even though they may be slightly different than most in terms of time frame. If anyone has had a walking cast I would be curious to know how long it took to be able to walk crutch free. Thanks and happy Labor Day to all.

    Last edited by smile2006; 08-30-2008 at 02:21 PM.

     
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    Old 08-30-2008, 06:22 AM   #2
    hurts2walk
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    Re: 2 1/2 weeks after PTTD Surgery

    Thanks for this post! I am scheduled for posterior tendon transfer and osteotomy next Friday the 5th. I appreciate other "survivor" stories! You sound very positive and like things are going well. I am not looking forward to casts and boots either. Do they do an xray at that first appointment to see how the heel is healing? How long did you need pain meds?

     
    Old 08-30-2008, 06:32 AM   #3
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    Yes, they did an x-ray at the first appointment. I choose to stay on pain meds for a week after surgery. I don't feel very alert while on them so I needed to clear them out of my system before going back to work. For me the first week was the most painful and things have gotten better daily since then. I have been taking regular Tylenol now and then usually at the end of the day if things feel achy. Good luck with your surgery, everyone has different experiences but so far I have been happy with how things have progressed. If I can get to the point of walking in this cast crutch free that will be so helpful to getting back to normal. The first cast/splint right out of surgery was a pain because it was so heavy. The fiberglass casts that followed are so much lighter.

    Last edited by smile2006; 08-30-2008 at 02:20 PM.

     
    Old 09-01-2008, 07:49 PM   #4
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    Re: 2 1/2 weeks after PTTD Surgery

    Thanks for the update professor. I hope that you continue to do well and post your progress, especially with regards to resuming your pre-operative physical activities. Sports and running after PTTD surgery are questions that frequently come up, and it would be nice to hear from someone firsthand how things go. Don't forget about this board when you are feeling better and your foot is back to normal. Please keep us updated!

     
    Old 09-02-2008, 02:41 PM   #5
    sunny77
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    Re: 2 1/2 weeks after PTTD Surgery

    Good to hear you're doing well and that your dr appt went well! I went back to work after 3 weeks and wouldn't have had it any other way...I'm not the type to sit around and I hate to be bored! Mental stimulation and being around other people helped a lot. Sounds like you've been able to make it work well for you too! I'm a bit surprised that you've been told you can bear weight when you're only 2.5 wks post-op and that you should be walking unaided by 5.5 wks post-op? The Dwyer is a bony procedure (osteotomy) like the Evans and that required 6-8 wks of being NWB, no touching ground, crutch walking or anything because essentially there's a broken bone in there trying to heal. I saw the Dwyer listed as 8-10 wk NWB...so your dr must be on a different timeframe! Be careful...you don't want to do anything to harm your foot and keep you from running! It takes about 4 months to get to that point...lose strength, flexibility, etc (I still have a wimpy calf muscle! even though I've been running for awhile now (unfortunately not pain free yet). Good luck as you move forward! The worst is over!

     
    Old 09-02-2008, 03:35 PM   #6
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    I was a bit shocked as well when he said to be walking unaided on the walking cast in three weeks. What was done to my heel did involve the bone. I have been hobbling around just a tiny bit with one crutch and took about 5 steps both yesterday and today totally unaided. It is actually much less painful today (Tuesday) than it was Friday when they put the walking cast on. I couldn't sustain any distance walking at this point for sure. I definately don't want to ruin the work done but he said to start bearing weight on this cast. I'm still looking for someone else who had a walking cast. I'd love to hear their experiences and how they handled getting into weight bearing mode. This cast is so different from the first one I had in terms of the angle of my foot and the shape of the cast. I've noticed the little bootie makes my foot really hot here in SC where the weather is quite warm yet.

    I am so ready to be active again. When they changed the cast on Friday I already noticed that my calf was disappearing as well! I did sneak in some upper body weights today though....felt wonderful to do something physical and yes, for me getting back to work was the perfect thing to do. My students keep me going and encouraged in all this, plus they love my hot pink cast even though I won't let them sign it

    Sunny- You indicate running is not yet pain free. Can you elaborate a bit on that? What problems are you having? Do you feel the surgery did it's job?

    Last edited by smile2006; 09-02-2008 at 03:37 PM.

     
    Old 09-02-2008, 07:56 PM   #7
    sunny77
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    Re: 2 1/2 weeks after PTTD Surgery

    oops, see next post.

    Last edited by sunny77; 09-02-2008 at 08:10 PM.

     
    Old 09-02-2008, 08:09 PM   #8
    sunny77
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    Re: 2 1/2 weeks after PTTD Surgery

    I had PTT repair and an Evans osteotomy in both of my ankles/feet and the experience was slightly different in each. The first was 2 wks w/ a splint, 4 wks in a fiberglass cast (so 6 wks NWB) then 4 wks in a walking boot. The second time around I was 2 wks in a splint, then spent 8 wks in a boot, 4 of it NWB and 4 walking. Everyone transitions from being NWB to PWB to FWB differently. In both of mine, I was FWB w/in a week (used one crutch during the PWB week). I certainly couldn't walk long distances and limped, was slow and was sore and swollen a lot of times (especially if I tried to do too much walking). You really have to listen to your body...if it's not ready to do it and is painful, that's a sign to back down a bit. Icing and elevating are important too. Stamina is definitely not there...the rest of you can keep up, but your foot can't. If you're not fully bearing weight and walking w/in the 3 wks your dr said, I don't think I'd worry too much...it seems like that's pretty ambitious and can make you feel frustrated when/if your body doesn't cooperate quite the way you'd like. You have a lot of healing going on down there!

    As far as running...it was fine at 4 months on my first foot, but then my second foot started going downhill since it took the brunt of everything. The second time around it was 5 months before I ran and it's been a bit painful since (i'm almost 7 months post-op). The surgery did what it needed to, I'm definitely not flat footed or overpronating and that pain is gone. Per my dr and PT instructions, I got cushioned, neutral shoes since I now have higher arches. I'm actually underpronating (supinating) too much, possibly due to hypermobility that has always been in my foot. It's causing pain in the peroneal tendons (which have an attachment at the middle of the lateral side of foot), the IT band, hamstring. Kinesiotape has helped when running and the pain usually subsides after I've run for a bit, but if I walk at all, it hurts to start running again. It takes time to adjust to a whole new foot, a new way to run. My stride is different, I have a more narrow base (I used to be more bow-legged, now they're fairly straight due to surgery). The way I was instructed to start running again was to run 1 min, walk 1 min, then run 2 min, walk a min, and build up...it takes time. I'm up to 25 minutes continuous now, hills (up) included (can't run down hills...kills the IT band yet). Anyway, I'll stop rambling for now. Maybe some of the other runners here can post their experiences too.

     
    Old 09-03-2008, 04:36 AM   #9
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    Thanks for the insight about getting back to running. Biomechanically everything is connected. I have been lucky enough to run injury free for my entire life and having this surgery concerns me greatly. It just seems that a "new foot" would have to impact things like stride and alignment in addition to shoe choice. I have worn a particular neutral NIKE running shoe for last 10 years. It seems possible that shoe might no longer work on the surgery foot (although I will say that as my foot was getting bad this shoe was not fitting as well so maybe the shoe will go back to fitting well). While I can only hope that a better aligned foot will lead to better mechanics I wonder if it will just feel really different to run now and if other parts of my body will be stressed differently (possibly knees and back). Last week before the walking cast was put on I noticed some mild pain in the outside of my surgery side knee from holding the cast up and crutching around!!. Luckily this has gone away. I haven't had any knee problems to this point but I was a gymnast and my lower back can be touchy at times. I'm 43 so not quite as young as I used to be. I think the 1 min on 1 min off running sequence is great way to get back into it. My immediate problem will be finding a flat place to try running again as the area around my house is so hilly. Maybe I'll go to a track. My doctor suggested first activities should be the eliptical machine and stationary cycling. I'm not not exactly sure when he will let me try any running but as you (Sunny) said, my body will know when it is OK.

    I'm glad you were full weight bearing in a week when you started walking. I was able to do 10 steps this morning without crutches! My foot feels so much better right out of bed than later in the day. Hope you continue to progress!

    Last edited by smile2006; 09-03-2008 at 04:43 AM.

     
    Old 09-05-2008, 05:38 PM   #10
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    Update- The week has gone well. I'm 3 1/2 weeks post-op now. I'm able to walk about the house for short periods of time with no crutches. After about 10 minutes of walking unaided on the walking cast my heel area starts to feel a little tender. I notice when I sit down and elevate for a half hour to an hour it calms down. I am still using crutches at work when I am moving about more consistently. My toes are much less swollen and red this week and I'm feeling my foot again (numbness is subsiding to a noticable degree). My husband laughed at me as I was able to fire up the weedeater yesterday and trim around the mailbox which took only 10-15 hobble steps...a small effort but but overall everything feels better than last week. Hope all those also in recovery mode are doing well. A question for anyone post-op- How long did you sleep with your foot elevated? I'm still sleeping with my foot on a mound of blankets and I'm wondering if this makes a difference at this point.

    Last edited by smile2006; 09-05-2008 at 05:39 PM.

     
    Old 09-12-2008, 12:58 PM   #11
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    Update again I'm now about 4 1/2 weeks post op. I'm still in a walking cast. This week is better than last. I am probably walking without crutches about 50-60% of the time and the rest of time I am able to get around using one crutch. The swelling has definately come down more and I'm really starting to get feeling back. One tip to others... I notice walking on the walking cast is most comfortbale for me with a soft soled low heeled shoe on the opposite foot. I have a black pair of Clarks shoes that work super well, even better than a running shoe in getting my good foot/leg at a high enough level to really be at the same height as the walking cast foot. I'm looking forward to one week from today. I might be freed from a cast at my next appointment and move to a boot although my doctor has used the term air-cast. Can't wait to be able to wash my foot and lower leg, as well as, be able to start light activity such as stationary cycling which is a possibility if the oestomoty site looks good. I wish much "good luck" to anyone who may be in the path of IKE, be safe.

     
    Old 09-19-2008, 02:31 PM   #12
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery...Update at 5 1/2 weeks, cast free!

    I am now cast free. I had an appointment today and got my walking cast off. I now have a walking boot, the type with an inflatable liner. My x-rays showed nearly 100% bone healing at the osteotomy site which was good news. I had been walking pretty much crutch free with the walking cast for the last several days except for longer treks around campus. I find the boot much more comfortable than the walking cast. It's a more natural walking feeling. It was quite natural to transition from the walking cast to the boot and I did a Home Depot Stop on the way home from my appointment. Was great to walk and shop for some fall flowers for the garden!!!!

    I just got done soaking and really washing my foot. I echo others who have mentioned the peeling skin. My foot was a mess with dried skin, especially on the toes and heel. I got much of it off with a little soaking and a sudsy bath with cocoa butter and vitamin e soap. My foot/skin looks and feels much better now and it was great to shave my leg (the nurse said to wait three days to shave since the skin is tender but there was no way I could wait that long to shave). It is quite weird to touch my foot as there is still swelling and a little numbness on the medial side. One question I have for others is what type of lotion have you used on your foot and/or scars to soften them up? My doctor said anything with vitamin E???? The scars are still very much new and still have some dried skin/blood around them which I was told not to pick or scrub off too harshly.

    What a relief to have the cast off although I must say the walking boot is quite ULGY and bulky (I did not have one before surgery). My wardrobe options were limited with the cast and I think will even be more limited with the bulky boot I start PT on Wednesday and the doctor is allowing me to do stationary cycling on my own trainer/road bike (very light resistance). My husband has set up my road bike with my mountain bike pedals which are flat. There is no way I could get my foot in a cycling shoe but I can do easy pedaling with a running shoe very loosely tied. I'm happy to be cleared to stationary cycle on my own. My doctor is also allowing swimming and the eliptical machine on my own as long its kept reasonable. So the 5 1/2 week mark is positive. I'm actually suprised how quickly the time has gone since having the surgery. I go back to the doctor in 4 weeks at which point I'll hopefully be out of the boot. He also said in four weeks we could evaluate whether I could start running again.........happy, happy, happy dance!!!!!!! Good luck to all those in recovery. I hope you find the light at the end of your tunnel as well.

    Last edited by smile2006; 09-19-2008 at 02:55 PM.

     
    Old 09-20-2008, 07:00 AM   #13
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    Re: 2 1/2 weeks after PTTD Surgery

    I was able to do 30 minutes of light resistance cyling on my stationary trainer today. That really loosened my foot and ankle up and got the blood flowing. I noticed much better range of motion after doing this especially in my ability to point my foot/toes downward. I was also able to stand on both feet with running shoes on. I took about five steps in running shoes and it really didn't hurt which was very suprising (I think my foot was really warm-up from the cycling). I'm not sure if I should be doing that but it really didn't hurt just felt weird with the lingering swelling and numbness. To be safe I don't think I'll do that unless the PT says it OK when I go in on Wednesday. Sleeping without a cast was wonderful last night as well.

    Last edited by smile2006; 09-20-2008 at 07:07 AM.

     
    Old 09-20-2008, 08:50 AM   #14
    hurts2walk
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    Re: 2 1/2 weeks after PTTD Surgery

    Yay for you! I am jealous! Being NWB seems endless....I cannot wait to walk again! Thanks for the updates....gives me something to look forward to.

     
    Old 09-20-2008, 06:45 PM   #15
    smile2006
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    Re: 2 1/2 weeks after PTTD Surgery

    Thanks Hurts-to-Walk. I know your time will come too for weight bearing. Good luck with your recovery. Are you doing a bit better with the nerve pain? I remember a day or two probably a week after surgery I had some very sharp nerve pain, sharp enough to make me yell out on one occassion. It did settle down after a couple days, hopefully yours will too. I can honestly say the first three weeks were the most difficult but everyday does get better so hang in there. My husband and I went out for a nice dinner tonight and it was nice to not feel as if I needed to prop my foot up on a chair!!! Once the throbbing is gone everything is so much better.

     
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