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  • Brace to nothing transition not going smoothly

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    Old 03-13-2015, 08:19 PM   #1
    JustMeJen
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    Brace to nothing transition not going smoothly

    I've mentioned this before on here but I was told I could start walking without a brace on Dec. 31 but brace on when it was risky. Whether or not I was allowed to (the nurse was confusing so I did it my way) I'd been walking inside barefoot for a couple months before that but always braced in shoes/outside. I never wear shoes inside so was just more comfortable and more normal without anything inside as I could tolerate it.

    I was out a few times without the brace before it became terribly snowy and icy and I wasn't safe without it. So now I'm 2.5 months behind on that.

    I've had a few days I've been out and about without it this week and have pretty much learned that I'm going back in time to what would have happened in Dec. (at 6.5 months post-op) and if I don't wear my brace I swell a lot, it hurts and I can't go as far as I'd like. My mom tells me that I'd reached a point I wasn't limping with the brace at all but am not walking much less steadily and am limping again.

    I'm sure I'll adjust to this. I am giving it at least 3 weeks (until after vacation) to work itself out but I'm thinking I may need to go back to PT for a little bit. I've lost some dorsiflexion and both dorsiflexion and eversion are a little tighter than they were 3 months ago. I feel tight and not sore but not comfortable with those movements and I'm concerned that is why I'm not walking as well without a brace. On the other hand my brace was pretty supportive and so going without is a big change. And as long as it is swelling and adjusting I don't really expect it to do well.

    I know that this isn't the most common way to do this. I certainly wish the weather would have allowed me to just transition smoothly from brace to shoe but that's not what happened. But I'm just interested in how that transition went for other people who probably did it on schedule.

    If I'm still not doing things well after vacation I'll get PT orders from my family dr who will be fine with sending me back. I hate to go back simply because I'm finally getting the bills from surgery and don't want to add medical bills (I paid estimated PT co-pays to save 20% so it's paid for but very little of surgery has been paid at 9 months out thanks to Medicare being obnoxious) if I don't have to. I can go back to the ortho but what is he going to say that isn't obvious: should have transitioned 2.5 months ago and now it's harder because the brace was used so long.

    I've not heard much about this transition from others. Is it generally seamless or is it like the other transitions, a little hard for a few weeks and then better?

    Thanks!
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    Old 03-14-2015, 05:17 PM   #2
    dama
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    Re: Brace to nothing transition not going smoothly

    i think you know my story by now, we seem to be connected with the timing

    it took me almost a month for my foot to feel more comfortable breaking into my shoes where the brace was. on the back, the incision, and even underneath my foot felt weak in those areas as well as the skin being agitated easier. i had to wear thick socks and put tape on heel.

    i felt like my range of motion was more as well without the brace like i was stretching things out more during real world activities. with that came what i call another breaking in period. for me it was hiking so i introduced myself slowly because my steps felt new and i was scared without the brace.

    i had the same pattern where i would go like 5-6 days of doing my thing and then get aches/pains and back off and hit it again. i strung together a massive amount of hiking in a 2 month period and was feeling very positive at that point.

    i started to get a side to side tightness that didn't seem to effect my normal movement. however i noticed if i tried to pivot or do an extreme angle step like on a rock. something i wouldn't think twice about with my good foot. whats wierd is it wasn't always like this, which is mimicing a wobble board.

    so i continued on and a few weeks ago it started to become more annoying with pinching that does effect my stride and i limped one day which i haven't had to do in months. i have taken 2 , 5 day breaks recently and my foot is just now starting to settle down as far as what i percieve as the pinching pains. side to side is still tight.

    so i would say its like learing to walk again and you have to be carefull. im still not totally connected to my foot i started to wear my brace like you suggested and plan on getting active again this week.

    i will also visit another doc but i have issues with the health insurance and needing a new doc, obamacare kicked me to medi-cal due to damages i suffered from injury.

    if you had asked me weeks ago i would have said i still had issues but felt since i progressed thus far i just had more work to do. now im scared and paranoid about my foot and wished i kept the brace on even though im not aware of any trauma i suffered.

    another thing is i quit with the rehab exercises when i started doing all this hiking and figured i would back off due to all the activity. i am now wondering if i messed up and should have continued massage and all the balance, stretching, theraband exercises religously.

    i also wonder if weight training is a key to all this and getting everyting else real strong to keep things in place. i have noticed as i dabble in this recently that its totally different than cardio and hiking and it feels like i have been ran over. its going to be hard for me to go to the gym but i have to try, i think it may be a part of the puzzle.


    just curious if you know in cases like ours, can a new doctor get a good idea of whats going on by manual manipulation to make sure things are atleast in place and solid? i just wanted to prepare myself for new docs i don't want to take any info with me and don't have it, i want another opinion. i figure surgery is out of the question for these things.

     
    Old 03-14-2015, 06:21 PM   #3
    JustMeJen
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    Re: Brace to nothing transition not going smoothly

    The doctor can tell a lot from manipulation. It is probably still helpful to have anything you've got like xray reports, MRI or (probably especially) your surgical report if you have that. I keep meaning to request mine. Obviously the MRI and xrays won't be accurate but I think it's better to go with extra information than not enough. I know I did have one set of xrays after surgery as well and that particular report (and I should have 2 others that were done at the hospital where I had surgery) I actually have on my online chart. That's when I found out I had accessory navicular bones; nobody had ever told me before and it wasn't mentioned in my MRI (which also didn't mention my peroneal tears).

    When I saw my surgeon the first time I had a bunch of xray films because the dr before him hadn't been able to find the previous fracture so my podiatrist had gone through the many, many xrays he took over the years and sent about 12 that he thought showed the issues best. I also had my old MRI report and then I had xrays that day (I'd also had them 2 weeks before at the same hospital but they needed one more view or something). He wanted another MRI but I didn't want to pay for it (I wish I had now; I think everything was fixed but it would have been smart to be certain of that) so we didn't do that and everything was diagnosed by feel and the recent AFTL rupture by feel and my description.

    Sorry you have to deal with meidcal to get through this. I have Medicare due to disability but also have medicaid as a backup. I have to spend a lot of money (well over half my income) before it kicks in so all it is really helping with is the money I had surgery. But trying to track when I have paid the magic amount turns out to be really stressful and yet 20% of $43000 is a huge amount and I still have a lot to pay with PT and 20% of follow-ups, xrays and casts, boot and brace so I'm glad to put in the extra effort if I must. (I'm still hoping their computer system sorts it out somehow). I generally want to hide when I think about it.
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    Old 03-21-2015, 09:44 PM   #4
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    Re: Brace to nothing transition not going smoothly

    DMAC-I think that hiking boots are bad. I am finally in sneakers and no brace and also back to limping a little and having to work on gait all over again. At first I was afraid I was going to have to go back to PT but it is getting better now slowly. However, I am pretty convinced that the hiking boots I was wearing for traction were making me a lot weaker. I've been working a lot more on the balance board and my ROM is back to what it was in December and my pain is down to just sore if I do too much. I'm working on standing on just the surgical leg on the balance board for as long as possible and am up to over 30 seconds (probably 45). I started doing 1 leg squats on it today. Not big squats but I'm keeping my balance with them so I'm excited. I also can do circles just standing on that leg. Next up is trying to do heel raises on that leg on the balance board. Obviously with something right there to grab and I'm holding on for the squats (well, keeping my hands within a quarter inch of the couch and counter and when I am down I'm holding on).

    Anyway, I'm much less discouraged now than I was and I think backing up to things I hadn't been doing as much has been good. I am also taking walks now that I can safely and hopefully I will be able to go to the nearby state park and start walking on the very uneven pavement since I get off balance really, really easily still. Hiking is a ways off yet but I'm so excited to be brace free, especially now that it seems like it is improving. I have a feeling that I'm not going to be 100% at 12 months because I did get delayed by 2.5 months but that's fine as long as I get to 100% at some point.

    I hope you are doing better. I've been meaning to post this for a while but I just have been distracted and forgot.
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    Old 03-22-2015, 01:37 PM   #5
    dama
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    Re: Brace to nothing transition not going smoothly

    i forgot to say that i was pretty confident without a brace on concrete or gym like settings months ago. its hard to explain but i was doing stairs and all of that and just kind of went with the flow. i felt like when i attacked things head on, even jogging it was a safe environment.

    and i forced myself to go without the brace on the hikes, etc. just to prove a point that i could get into awesome shape again.

    but i started to wear the brace again during work and will going on future hikes, but i have taken a couple weeks off to take care of some things.

    i will go back to another doc soon and share what they say but at this point i have decided i won't obsess about that brace and just wear it. i don't feel like i need to at the gym or everyday stuff, just my hardcore exercise.

    the pains i mention i can only assume are from how hard everything has had to work during those hikes with lots of rocks, etc.

    i really need to lose another 20 lbs and hiking is the best for me but i also have decided i am going to start doing the proprioception drills, wobble board, therabands, etc. religously now as a long term plan, i don't think it would hurt? i also want to hit the weights up to do strength training to see if this can help in some way.


    doing all this crazy activity i can tell you that my proprioception is still off and that i have had a few incidents with rolling type action where i corrected but if felt delayed and moving in that manner felt like i was stretching past my normal use, maybe thats why i have the pain.

    maybe the operated foot will be tighter than im used to before and these pains are a warning that it just won't be the same.


    i also feel like i can jog, but will not play basketball or tennis or sprint and cut. too risky for me and i just don't feel im capable of my peak performance.


    despite all these issues i still feel like the function is good so im hoping my repairs have held. i still get aches up the outside of leg so i fear like you said there is things going on in the repair area, my impression is that outside ankle bone is one general mess of some sharp pains and aches.

    i did something by accident the other day where i layed my bad foot down on my side first and the other on top of it and i felt the pain/pressure just the same in that general area so there must be some tenderness going on that isn't directly related to the side to side stretching.

     
    Old 03-22-2015, 06:30 PM   #6
    macyk
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    Re: Brace to nothing transition not going smoothly

    Curious what brace all of you have used? I was told to ditch the boot and go directly to shoes 2 weeks ago. The transition is very hard, I find myself using 1 crutch 30% of the time. I prefer barefoot. Are you using orthotics? Now that I am out of the boot my foot swells half way thru my day and I find myself limping.
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    Old 03-22-2015, 07:08 PM   #7
    JustMeJen
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    Re: Brace to nothing transition not going smoothly

    I was given an Aircast Airsport which was pretty supportive; 2 big plastic lateral supports and a slightly compressive band around the foot. I didn't love it because until I was confident with walking I had to tighten the strap a lot but once I was used to it (and I also had to get used to it pushing on my incision) it was fine. It wore out and I used a lace-up figure 8 brace for the last few weeks of winter which is a little less supportive.

    I do wear orthotics and actually had to start shoving my orthotic for my surgical foot into the compressive sleeve so that I had that support because the combination of not enough support without it and scar tissue that formed on the bottom of my foot along the arch which has torn and caused pain was not manageable without it. My orthotics are actually pretty old (5 years?) and I was surprised that I didn't have to get new ones with the changes in my foot but he said as long as they didn't hurt they were fine. Unfortunately the surgical foot is starting to hurt.

    I was much more comfortable barefoot and have been since I was first able to walk without them. Until surgery I always wore slippers inside my house and shoes outside; now I wear slippers only if I'm going to the basement with its concrete floor and go barefoot the rest of the time. I even need sneakers that had a ton of flexibility and let me "feel" the ground for the same reason; I'm not comfortable with more than than a little sole between me and the ground. The shoes I went with can be folded in half and that really made a big difference to me. (I ordered literally $1000 of shoes online and tried all of them on and messed with them until I was sure I was comfortable and supported in one pair and then returned the rest for free. I actually just remembered I have one pair that I need to return still). I had limped and been braced for so long that I had to completely re-learn normal gait and now and working on that yet again as I learn to walk without the brace.

    My dr had me shift to the shoes and brace by just an hour or so a day. At first it was 1 hour in shoes/brace with 2 cruches, then I increased the time. When I was comfortable without crutches in my house I did that. When I was comfortable walking outside with the shoe/brace but crutches/crutch I did that. I don't remember how long it took to be down to just the brace and shoe but I'd say 2-3 weeks. I started at 16 weeks to transition. I know I was able to get into PT with shoe/brace and 1-2 crutches pretty quickly using handicap parking at first because I was eager to show off there (and tired of having to bring a shoe and crutches so I could move around between exercises when my boot was off).

    I didn't have a lot of swelling while transitioning to shoes but that was done so gradually. I have been swelling when I'm out for very long without a brace and that's frustrating, partly because I just didn't expect it. I was not limping with the brace but now am again according to my mother. I know I don't feel as steady with this transition and hope to make it through soon.

    I think going straight to a shoe would be pretty difficult and that you're probably reasonable for needing a crutch at this point. I'm surprised he didn't have you go more gradually. What does your PT say?
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    Old 03-22-2015, 07:59 PM   #8
    macyk
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    Re: Brace to nothing transition not going smoothly

    When I go to P.T. I leave my crutch in the car. I feel they are really pushing me to walk unassisted. My P.T. Is costing me $100 out of picket each visit and I don't plan to stay forever. Thanks Obamacare, I have already spent over $25,000 out of pocket since this last surgery. My Ortho did give me a script for new Orthodics and advised me not to wear my old ones on my surgical foot. I now wear a mule slip on shoe made by Merrill due to heel pain where the screw is bulging. I have yet to try sneakers but hope too soon. My Physical therapist has treated me since my first surgery in 2013 and I have lots of confidence in him. It is a long road and I am ready to get on with my life. Happy healing and thanks for the help.

     
    Old 03-22-2015, 08:45 PM   #9
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    Re: Brace to nothing transition not going smoothly

    Wow, that's awful. I had to pay $50/PT session after my initial injury and it was awful and at least with that I could say "this isn't working, it costs too much, forget it". (I went to a very, very bad PT place that time, chosen for it's closeness to work instead of its' merit, a very stupid thing to do when I knew lots of PTs who could have referred me anywhere and probably would have warned me away from where I went because it had a reputation....even my PT after surgery (60 miles away from that place) knew it as a cookie-cutter therapy place.

    I hate being disabled with all my heart, soul and might but it does give me one thing: Medicare and Medicaid that kicks in if I spend too much and so that will help with most of the actual surgery co-pays and it kept PT down to about $10/session or something (it's still working its' way through the system).

    When does your screw come out? It sounds like that is your problem with walking and that seems reasonable; that sounds like an awful experience. Can you get accurate orthotics done before the screw is out?

    Right now I think my orthotics are kind of helpful but not perfect anymore. As soon as I can find $300 for new ones and a new podiatrist I'm going to get new ones. My foot has changed since surgery, not as drastically as yours but there is a difference, particularly there is more arch since I'm not so badly inverted and it is not flattened by inverting all my weight onto it. But for now I'm counting it as not emergent with surgery co-pays, potentially more PT co-pays, and an enormous vet bill because one cat nearly died from pancreatitis followed days later by the other cat getting UTI. (Urgh).

    I hope you have good healing and feel better with walking soon.
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    Old 03-22-2015, 08:59 PM   #10
    macyk
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    Re: Brace to nothing transition not going smoothly

    Good question on Orthodics before screw removal. He did tell me to get Orthodics soon. My foot is swollen causing my narrow shoes to fit tight with no insert, I can't imagine fitting an Orthodics in there yet. My next appointment with my surgeon is early June, no idea if he will want to removed the screw then or not. Three of the fusions are fused and we are just waiting on the 4th one. My physical therapist is working on desensitizing the nerve that is near the heel screw. I do believe it is working. I had a brace from years ago and may try adding that tomorrow along with the lidocaine creme. One day at a time is becoming my new motto.

     
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