New Ankle New Me

Swelling and Walking and Pain and Swelling

9 weeks after my first operation and 6 after the second I was finally weight bearing. The instructions were to take it easy (and slowly), wean myself out of the boot and into an A60 splint. I could use crutches as required and walk barefoot around the house.

All sounds so easy…..

I had barely finished celebrating when I found that I had hardly any shoes that fit! No matter how much I had convinced myself that the swelling was minimal my shoes don’t lie. While the splint adds a little extra width in a trainer the swelling added quite a lot extra. I had all these plans for outfits that I could wear with matching footwear but it turned out that I only had one pair of trainers that fit.

At this point I clearly still need to elevate my foot as much as possible.

And then there’s the pain. Apparently the best form of pain relief for your new ankle is not to use it! As soon as I started weight bearing the pain level increased. This is not entirely as bad as it might seem as pain is a very good way of letting you know that you are overdoing it. So it’s time to tune into what my body is telling me and to take things slowly – don’t run before you can walk. (I always knew I would get that pun in at some point!)

Onto walking: The gait is all over the place. I am limping heavily, although in the splint and trainers it does improve. I find that on very short walks I can manage with one crutch but for anything longer two is best and a great assistance with the pain. I’d rather go on two crutches than take pain killers. The pain seems to come mostly from the heel and the Achilles. It’s not a sharp pain, more like a really bad ache. It’s mostly bearable and it is still very early days.

I’ve been driving my automatic car for a few weeks now. Luckily it was my left ankle that was operated on. This gives me the chance to get out without assistance and gives me some independence. I really enjoy swimming. It doesn’t seem to stress the ankle at all and I feel so normal in the water. I’ve been using the buoyancy to take my body weight so that I can practice walking as normally as possible. I’m also visiting the gym regularly and using an exercise bike, which is helping me to regain the strength in my legs without stressing the ankle.

I’m also making use of an ice pack to help to reduce some of the swelling and I like to give my foot and ankle a massage at least once a day with a generous application of Bio Oil. I give my ankle a good wiggle to test the range of movement. Best of all though is that I can now finally carry my own drink.

Did I mention swelling?

Seven Weeks and Counting.

It’s been seven weeks since my ankle replacement and 4 weeks since the second operation. I’m now out of plaster and back in the Aircast walker boot. I’m still non-weight bearing, however I can now sleep without the boot on, take a shower and wash my leg and give my new ankle a gentle wiggle.

The recovery from the second operation wasn’t too bad. The pain on discharge from hospital was minimal, just requiring paracetamol for control during the first week. Having had two bones in my foot broken I’m limited to non-weight bearing for around 6 weeks to allow for them to heal. So I still have to deal with the frustration of feeling healthy but being restricted by the use of crutches.

I am now making good use of the gym which I returned to around 5 weeks after the first operation. There are lots of resistance machines that I can sit at and push and pull weights around. Also, since the second cast was removed and I was placed in the boot I have been swimming again. Getting in and out is challenging but once in I am able to swim comfortably and my ankle is not feeling at all stressed by it. I would always advise caution with this. I have found that it is easy for the crutches to slip from under me but luckily for me the surface around the pool and changing areas is non slip and if I take it nice and slowly I can negotiate it safely. I have to crawl into and out of the pool, not very elegant but well worth it for me.

The ankle itself is quite stiff. I find that it frees up a bit with movement but is nowhere near as flexible as the other one (early days yet). There is some swelling and I have a network of scars. During the evening when I’m sitting with my foot up I have taken to gently massaging the foot and ankle with some Bio Oil. This should help the scars to heal and decrease the swelling a bit too. Any pain is minimal and usually felt first thing in the morning on waking as nerve pain. I’m not sure if this is from the first or second operation but I mostly feel it on the top of the foot and find that the ankle is very comfortable.

On days when I don’t go to the gym I have an exercise bike which I have been using. I started very cautiously with just one minute and built it up to 15 minutes now. I tend to work my good leg harder but find that the ankle is well supported in the boot and does not suffer any ill effect from cycling. Again I would advise caution. Listen to your body and don’t overdo it.

I have been working from home since my first operation and although sitting at the desk was uncomfortable for the first two to three weeks, it is fine now and I can complete most of my work now with just a few additional emails flying back and forth to the office.

I have been home alone for a while now and have made one or two small adjustments to cater for this. I have a travel mug with a lid and handle. I make my tea or coffee in this and can carefully carry it through to wherever I might be sitting. I also prepare my lunch in a bowl which I can manage to carry around without spilling the contents (DO NOT do this with soup!) I have a back pack which I use if I need to carry anything else and also a big bowl which I can put things in and kick around from room to room. Life has slowed down significantly for me but that is not necessarily a bad thing.

Another Operation

During my operation Mr Goldberg found that there were some problems with the dynamics of my foot that would adversely affect my new ankle if left untreated. So we decided to proceed with further surgery which was to take place three weeks after the original op. This gave me exactly three days before I was back in plaster again.

As luck would have it the sun came out and I was able to enjoy taking off the walker boot and sitting in the sun. I had a bath, treated my foot and ankle to a bit of pampering, including moisturiser and a first application of bio oil. I didn’t have to wear the boot in bed. I even had a meal out and went shopping. Bliss.

So once again I was driven around the M25 early on a Monday morning for a 7am start at RNOH. This time I was first on the list. So I was hurried through all the pre-op checks, into a gown and down to theatre. The procedures this time were to be a dorsiflexion osteotomy to my fist (big toe) metatarsal and a calcaneal osteotomy to my heel bone. This involves cutting though the bones, re-positioning and re-joining.

On waking this time I felt much more alert and in significantly less pain. I was soon back on the ward, eating and embarking on my usual post op drinking as much as I could regime! This was going to be so much easier than the previous op.

Then when I needed to answer nature’s call, sat upon the commode, blood started dripping from my cast. This was a complication. I wasn’t forming the necessary clots required to stop the blood flowing (probably due to the blood thinning injections). I wasn’t going to be going home that day, instead I was bed bound, under instruction to stay put until the following morning. This led to the trial of me wanting to drink copious quantities of water but not wanting to use the bedpan every 5 minutes! Tricky….

Having got through that night somehow and with very little sleep in a noisy ward, (Why do the snorers always fall asleep first?) I was grateful for the start of the next day. I was allowed out of bed and told I would get a new cast fitted before being sent home. This gave me the opportunity to get some (slightly bloody) photos of my new scars before they were neatly covered up again.

Back at Home

It is important to follow your surgeon’s advice regarding weight bearing. In my case I was non weight bearing when sent home.

I was advised that I should be prepared to spend 55 minutes of every hour with my foot elevated above the level of my heart for at least the first two weeks. This is to help reduce swelling and aid in the healing process. This might seem like quite a long time to you but you will actually find that following this operation you will notice very quickly that when you put your foot down it does indeed swell up and become quite uncomfortable. Initially I found it very uncomfortable to sit at the dinner table for any time at all and was all too ready to put my foot back up as soon as possible.

Organise a place where you can sit/lay with your leg up. For me it was on the settee in front of the TV. I have a downstairs toilet. I think that if I had to go upstairs to answer the call of nature I might have stayed in bed rather than negotiate the stairs multiple times a day. I also come out of a general anaesthetic with an insatiable thirst, resulting in drinking literally litres of water and numerous toilet breaks. You have been warned! Again prepare to be sitting around doing nothing, books, phone, TV remote etc. all needs to be close to hand, along with drinks, medication and snacks as required. You’ll need someone to fetch and carry for you. Crutches require both hands. Pockets are useful but you really are limited on what you can move about. I bought a travel mug with a lid and handle and found that I could just about manage to make myself a coffee and carefully carry this through to the living room but that was about the limit of my independence at this point.

Another thing worth mentioning is that I was sent home with injectable blood thinning medication. I was shown how to administer this in hospital and found the process easy and pretty much painless. Honest….

I invested in a rubber cast protector and a stool for in the shower which gave me the luxury of being able to shower in comfort and safety.

For me I reckon that two weeks was about the mark before I started to feel like I could put my foot down for any length of time without it quickly swelling up and the toes turning purple!

At around two weeks I returned to the hospital to have my cast removed and the stitches taken out. My scar, down the front of my ankle, top of my foot was about 6-7 inches long with 14 stitches. I was pleasantly surprised to note that it didn’t look too swollen or bruised. I also had some steri tape to a couple of points at the back of my heel which I found out later was because the surgeon had lengthened my Achilles tendon. (Quite common to have this done with this procedure.) I was placed in a walker boot and able to take the first few tentative steps on the new ankle (with the help of crutches). I confess that for me this was one of the scariest parts of the whole process. Surprisingly the pain I felt wasn’t from the ankle it was from the Achilles. It was at this point when I realised that the arthritis pain was no more.