May 22 – A Fine Day for Foot/Ankle Recovery!

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May
24

This is a documentation of a recovery from Post Tibia Tendon (PTT) surgery to a left foot & ankle on January 14, this year.  Until this past Friday, May 9, this recovery was only about strengthening the ankle.   The surgery, subsequent therapy and ultimately purchase of orthotics were all done by The Orthopaedic Foot & Ankle Center, see the link: foot & ankle They are located at   2922 Telestar Court, Falls Church, VA 22042, phone – 703.584.2040.  My surgeon was Dr. Daniel Cuttica.

Today, I had an appointment to see Dr. Cuttica my surgeon for this surgery.  I also saw the Orthotics person, Marsha, in the same office.  Last, I went to the blood clot doctor to see if anything further had developed there.  Overall, the day began and ended well as far as these three activities went.

First I was measured for orthotics.  Orthotics are shoe inserts for those who have foot problems, or pain.  These orthotics fit between the sole of the shoe and the foot and are made to exactly match the locations on the foot that do not contact the shoe sole on normal standing and walking.  The orthotics can be soft or harder and they give somewhat when walking, or doing other exercises.

Marsha is the orthotics fitter.  She has worked in this doctor’s office for 10 years.  For the 20 years before that she was into sports medicine and was a sports trainer for professional athletes.  Marsha and I discussed the orthotics.  She advised that the new set would have a top layer of thin foam which was not slick like my current vinyl orthotics.  She advised that I would walk back and forth a few times and dependent on how I did she would either use step-in foam or a computer mapping system to determine the contour of the orthotics.

We went outside the office and I walked back and forth several times.  Following that Marsha brought out a gray flat panel with a circle on it about 14 inches in diameter.  This device was plugged into a laptop computer inside Marsha’s office.  The device is made by Foot Maxx and is called a ‘metascan’.  I’ve included a link to Foot Maxx’s website: foot scanner.  Marsha laid the device on the floor and advised me to walk onto it three times with the left foot and three times with the right foot.  More specifically, I was to land my right foot before the device, then walk onto it with my left foot.  On turning around after this, I was instructed to land my left foot before the device and then walk onto it with my right foot.  I did this three times with both feet.  Following this, Marsha met back in the office with me and showed me both my feet on her computer screen.  The scanned photo below as well as the attached information is what the Foot Maxx device scanned from my walking over the mat:

The other information is the percentage of correct gait for both feet.  If you look close, on the right heel in the center is a small green dot.  Marsha said in a 3 dimensional walk the green ball flows up the foot from bottom to top and shows if the gait is exactly correct or off somewhat and what needs to be done.  Marsha said my right foot green dot indicates that I need a bit of lift of the heel as it has too much pressure there.  Well, Marsha was exactly right!  Currently, I wear my shoes down on the right rear heel.  So much so in fact, that with some shoes I have to replace them every 6 months!  To get back to my left foot, Marsha commented that the dot in essentially the center of the photo indicated the left foot was correct in walking.  Marsha printed the above photo out.  She advised I would be able to get my orthotics in about 10 days.  We discussed shoes a bit, but not enough to write about here.

Next, I went to see Dr. Cuttica.  He is happy with the progress.  He showed me that the inserted wedges on my foot had healed and the bone had accepted them and grown around the wedges which incorporated them into the foot.  I advised Dr. Cuttica the problem was not with my foot, but now with my knee.  Dr. Cuttica advised I could have knee replacement surgery in October.  Actually he commented that I could have the surgery six months after the surgery!! So if I wanted to I could get my knee done in June.  I think that’s a bit soon personally, so October it is.  I left Dr. Cuttica then and onward to the clot doctor.

At the clot doctor, I received another ultrasound which takes about 20-25 minutes to do.  Probably more if there is more area to look at.  After that I discussed what was found on the ultrasound.  What was found was the same tiny clot but Dr. Arryland was not worried about this.  He advised me not to worry about it that it was just a tiny residual.  He also advised that in the legs, each vein had a twin that came right beside the other one.  So, if there was a problem with one vein the other would take over the work.  In this case then, the second vein gets the blood and life continues on inside my leg.  So Dr. Arryland gave me a clean bill of health.  I’m not to see him again unless I have cramps again in my leg and something swells up.

Indeed, this has been a wonderful day for having good things done, and finding out everything is healing correctly!  Dr. Cuttica advised me to continue with my exercises even after the therapy was over.

Foot/Ankle Surgery/Recovery – Doing What Your Therapist Says

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May
22

This is a documentation of a recovery from Post Tibia Tendon (PTT) surgery to a left foot & ankle on January 14, this year.  Until this past Friday, May 9, this recovery was only about strengthening the ankle.   The surgery, subsequent therapy and ultimately purchase of orthotics were all done by The Orthopaedic Foot & Ankle Center.  They are located at   2922 Telestar Court, Falls Church, VA 22042, phone – 703.584.2040.  My surgeon was Dr. Daniel Cuttica.

This is a few comments on obeying the therapist.  About May 15, at one of my physical therapy sessions, I asked my therapist, Matt, about the possibility of returning to competitive rifle shooting.  I described the activity.  Now, Matt knew I also shoot shotgun in a trap league on Wednesday evenings.  I’ve been doing this from April after this surgery and there has been no issue from Matt.  I, had a couple problems with balance, but Matt had no issues with me shooting a shotgun after this surgery.  So I figured there would be no problems shooting rifles either.  WRONG!!!  After hearing the description of the activity Matt canceled me from rifle shooting until I received my new orthotics.  In fact, Matt commented that when I was at the rifle range for any reason I should wear my ankle brace!  The reason for this is that I’ve been running rifle matches since my surgery even though I’m not competing.  Matt advised that meant I’m standing a good bit as well as working my ankle at odd movements including side to side and the brace will assist me in that endeavor.

Matt also scared the hell out of me saying that though unlikely, long standing coupled with unusual movements could possibly cause the ankle to collapse.  Just what someone who suffered through surgery and subsequent pain following surgery wants to hear!  I agreed to use the brace.  Now, move forward to May 18.  I ran a rifle match.  I figured since I was running the match, I could sit more than stand so I didn’t wear my brace….yes, folks sometimes Roger is dumb.   I forgot that included with the actual shooting there is the morning set up.  This includes target set ups which are heavy.  After the set-ups, I stood a great deal of the time……Until just before the match was over.  Suddenly I was hit was an awful sharp pain in my foot, right underneath as well as the top right.  I had this awful sinking feeling that my ankle had collapsed.  (Thinking back on it now, I think it would have been excruciating pain if that had happened but this was still very painful).  Later, after the match was over, I sat down with another shooter and had some coffee.  Within 10 minutes my foot had no pain, and no further pain came on.  So I became unworried.

Fast forward to May 19th.  I had physical therapy.  Following that extreme exercise on my ankle, I then mowed the yard.  Again, did not wear the brace.  About 3/4 way through the mowing, I removed the grass bag off the mower to take it to the trash.  Suddenly I was hit with such a sharp pain in my entire left foot that I looked to see if I had ran a nail through it!  Not only was the pain intense, but my entire leg muscle weakened so that I had to stand on my right foot to stay upright!  Fortunately some stairs were right there.  I hobbled on over and sat down to wait for my foot to get better with the pain.  It never did get completely pain free.  I figured it was time to stop playing around with this brace stuff and put it on when I was doing strenuous activity on the foot.  Duh!! I believe that’s what Matt said.

I told Matt about these incidents of pain and he said back to me one of my own fav sayings: “I’d say that was a self-curing problem Roger”.  And indeed it was.  I have now learned – Never, Ever, ignore my therapist!

Foot/Ankle Surgery&Recovery: Re-learning Walking

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May
15

I’ll bet most people never think about walking.  Other than when they stub their toe, or trip over something.  But actually considering walking?  Why bother? Isn’t it automatic?  We all know how to walk…..don’t we?  Well, all except for a few of us that had surgery on our feet, or ankles, or knees.  Or those of us who are completely without those limbs.

If you have been following this blog then you know this is a documentation of a recovery from Post Tibia Tendon (PTT) surgery to a left foot & ankle on January 14, this year.  Until this past Friday, May 9, this recovery was only about strengthening the ankle.  As of that day, practice began on learning how to walk again, as well as the continuing strength training.  The surgery, subsequent therapy and ultimately purchase of orthotics were all done by The Orthopaedic Foot & Ankle Center.  They are located at   2922 Telestar Court, Falls Church, VA 22042, phone – 703.584.2040.  My surgeon was Dr. Daniel Cuttica.

A number of years ago I knew a prosecutor.  We got to be good friends and still talk by email sometimes even though he has long moved out of the area.  I had known him probably 7 years before someone told me had both legs amputated from being wounded so badly in the Vietnam War.  He walked absolutely perfectly!!  Since then, I’ve known or seen many more recent war veterans with severe leg injuries, or amputations.  Nearly all of them walk as though their legs were the ones they were born with.  I KNOW that must take long time therapy.  The knowledge of acquaintances with all these successful walkers is what encourages me to drive forward every day, every hour.  I KNOW I can walk normally!  Because I have all of these living examples of near impossible odds to begin with that all walk exactly right!

First was the standard stretching the skin and joints of the surgered ankle.  This happens at every therapy session.  I can’t honestly say I’ll miss it when therapy is over.  It hurts!  The good part of it is that it loosens the skin and joints before the exercise begins.  Next were the treadmill and the lesson on walking.  Matt set the speed at 1.1mph.  Not much for sure..  5 minutes he told me.  Off I went.

The problem with relearning to walk is that, for yourself, you only have your other foot to model your walking from.  It’s quite difficult to study your other foot while you’re attempting to walk on a treadmill and there is no stopping to analyze things.  I’m sure I looked funny to the therapists trying to twist around to see the other side of me walking.  It’s even funny for me to think about!  Finally, I realized I obviously know how to walk since I’ve been doing it so long.  I relaxed and began walking normally with my right foot, and the left simply copied the movements of the right foot at this slow speed.  As the days went by, I got more and more adept at walking with the left copying the right foot’s motions.  I surely know that cannot be how to teach a double leg amputee how to walk, but these are my methods.

As of my last therapy I was up to 2.0mph.  In therapy I’m still at 5 minutes.

The other aspect of walking has to be discussed as well.  That is of balance while walking.  When a person walks there is a second or more where one foot is completely off the ground.  If the other foot isn’t developed enough in the ankle area and calf muscle, when that foot comes off the ground, balance is lost and the walker begins to lose balance.  Depending on how much the foot/ankle has developed will depend on whether the person falls or not.

The exercises for balance are standing in one place and balancing on one foot for a time period.  In all of my therapy, that has been 10 repetitions at `10 seconds for each repetition.  In my last surgery of my right foot, that balance was 3 repetitions at 30 seconds each. Thank Goodness it’s down at 10 seconds now!  Another exercise for balance is a foam balance beam about 4 inches wide by about 6 feet long.  The patient’s therapy is to heel-to-toe walk forward, then backward 5 times.  Since the foam is constantly giving, this takes time and side strength to complete.  After the therapist believes the patient is doing well, then it’s time to play ball.  The therapist stands about 10 feet away.  Patient stands on the balance beam one foot in front of the other, heel to toe.  The therapist throws the patient the ball to catch.  Patient catches the ball and throws it back.  After a few times, the therapist begins throwing the ball on one side of the other of the patient so the patient has to lean to one side or the other and catch the ball.  This is more difficult to continue that balance.  After a few minutes of that, then the patient has to switch feet, putting the one behind in the front.  The patient quickly finds that the back foot is the one that has the weight on it and when the injured is behind, the balance is very difficult.  Following this exercise a ball is placed in a square on one of the gurneys in the room.  The patient stands back about 1 1/2 steps.  The patient steps forward with the new foot and removes the ball from the square then pushes off and stands up.  The ball is returned to the square in the same manner except by stepping forward.  These exercises build balance when walking.

Next will be a short lesson for me in doing what my therapist says do, or be in lots of pain.

Foot & Ankle Surgery Recovery Day 123

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May
11

This is the ongoing documentation of recovery from Post Tibia Tendon (PTT) surgery.  Day 118 was a glorious day in the recovery.  Upon arrival my therapist, Matt, discussed the pain level with me and issues I am having.  I advised Matt that I was shooting shotgun a few nights previous and found I could not seem to hold my balance enough to stand still.  This made me nervous that I would be unable to hit much.  I was also worried about having another incident of my knee seeming to give out as I stepped forward to step up my shooting position.  I also advised Matt I was worried about shooting rifle in competition because one has to stand balanced for a longer period of time.  In rifle shooting, rather than the same problem in shotgun, I was worried that the pain would be too great to shoot in competition as many shots in long periods are required in the competition I participate in.  Matt considered this and advised that from this day forward until he said different, I was to have my brace on while on any shooting range, but any other time I was to only have my old orthotic (pre-surgery orthotic) in the shoe, and no brace.

Woooo-hooo!!!  I had looked forward to this decision for a while!!  The brace is certainly good for holding me in place, but it seems to encourage my ankle to swell when I’m doing any exercises or simply moving around.  Naturally, the brace has to be tight around my ankle to do its job.  The job is just done too well sometimes and after strenuous exercise the foot swells larger than the brace and pushes against the brace.  This causes more pain.

I ran a rifle match, today, that I wanted to shoot in.  I quickly found out why I still cannot shoot in these matches.  I use boots on my feet to assist me in standing still for a steadier position.  Well, I can’t get my surgered foot into my shooting boot.  It’s too fat even with no duress on it prior to putting the boot on.  I was sorely disappointed.  Perhaps the next match I can shoot in it.  I have to wait till my foot loses its all-the-time swelling.

However, I did get another bit of wonderful news from Matt the same day as the orthotic news:  I can shower barefoot now! YAY!!  Matt looked my foot over carefully and determined I have no exposed scars.  Everything is closed up.  This means water can cover my foot, so there is no danger of infection.  Yippee!!

I thought readers want to take a look at the scars on my foot now, as well as the surgered foot in comparison to the right foot.  I agree, the left foot looks like it was in a battle – and lost.  I’ll describe the photos as to what they show.

foot comparison

The above photo is a comparison of the left foot with the surgery to the right foot.  The left foot is clearly larger than the right one.  Notice how the scar on the top of the foot has healed to that of a bruise.

outside left ankle

heel

In the above line of photos top to bottom. 1 – 4.  #1 shows the left (outside) of the left ankle.  Notice the swelling.  #2 shows the same ankle except a downward looking photo to better view the swelling of the ankle.  #3 photo is of the inside (right side) of the ankle.  #4 & #5 are photos of the heel showing the location of the spike, which has now been completely covered but with a little dot of white showing the spike’s location.

I have an appointment toward the end of May with both the blood clot doctor as well as Dr. Cuttica to look at the surgery results.  I’ll post the results of both appointments.  Stay tuned.