ankle replacement – 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.

The Big Day.

Every hospital has its own admission procedure. At RNOH I was asked to arrive at 7am. This is so that the surgeon and the anaesthetist can see you before they embark on their day in the operating theatre.

I was taken straight to the ward and allocated my bed. The nurse took some tests, blood pressure, temperature, oxygen saturation and asked a number of questions regarding my general health. I was told my number on the list – 6^th. At this point I was nil by mouth. The surgeon’s registrar came to see me, confirmed the detail of the operation, went through and got me to sign a consent form and drew a nice big black arrow on the leg to be operated on pointing down towards the offending ankle. The anaesthetist came next. He asked a number of general health questions, checked that I had no loose teeth and asked me to open my mouth wide. I explained that I suffer with motion sickness and asked for some anti-sickness drugs to be given to me.

There followed a very long, hungry, thirsty wait. I was finally asked to change into a theatre gown and taken in my bed to the operating theatre at around 4 pm.

I was wheeled into a small room where I was greeted by the anaesthetist and his team. A few monitors were stuck to my body, a blood pressure cuff put on my arm and a line inserted into the back of my hand. All this while the team happily chatted away to me. And then I woke up!

Now I’d like to be able at this point to reassure you that I woke up feeling really good with minimal pain. But I’d be lying. The nerve block I had been given during the operation hadn’t been effective so I was in pain when I came round. However this is not unexpected and the team in recovery are used to dealing with this. I was quickly given intravenous pain relief and a morphine pump was put in place enabling me to administer as and when I felt then need. I returned to the ward around 8pm and was carefully monitored throughout the night by the nursing staff.

Having had a pretty rough time with pain I was kept in hospital for another night and started on a routine of oral pain relief, slow release morphine and fast acting morphine. This kept me quite comfortable. I had a visit from the physiotherapist to assess my competence on crutches and arrangement for my care at home. The registrar came to see me and explain how the operation had gone. I was introduced to blood thinning injections which I was going to have to continue with at home.

After two nights on hospital I felt ready to leave. I was discharged with all the medications I would need including a carrier bag full on injections. I have no complaints at all about the care I received in hospital but it felt good to be going home.

The procedure I had used the Infinity implant with the Prophecy custom guide system or Prophecy Infinity. For a video animation of this amazing operation please see https://www.youtube.com/watch?v=2VGAceOy330

Preparing for surgery.

Make no mistake Total Ankle Replacement is major surgery. Not only are they inserting a shiny new ankle but a sizable chunk of bone will be removed. The recovery isn’t going to be quick. It’s more complex than a hip or a knee. The ankle takes a massive amount of stress through it. Being prepared for this and giving your new ankle the best chance possible is a really good idea.

So what can you do to help yourself?

Get in the best shape possible. You should know by now that excess weight is not your best friend. Hips, knees and ankles affected by arthritis benefit from less weight being put through them, so, apart from the usual health benefits we are all aware of, the less weight you put through your new ankle the better. You want this ankle to last. Ideally this will be your last ankle operation; you have a role to play in this.

Now obviously it’s hard to exercise when you can’t even go out for a walk right? And I was in a walker boot with a stress fracture now. Golf was out and initially I was uneasy about the fracture and swimming. My solution was the gym. I reasoned that any exercise would have to be done seated and most gyms have a full selection of resistance equipment at which I could happily sit and moves weights around.

Now I realise that the thought of going to the gym where everybody will be slim, muscular, fit and gorgeous is a scary idea. But the reality is actually quite different. Gym goers come in all shapes and sizes. Sure there are some like I have already described but guess what? Normal people use gyms: Old; Young; Fat; Thin. They are all there. I’m actually going to repeat this point: NORMAL PEOPLE USE GYMS.

So I started using the gym. Now back to crutches. When you have had your op you will be non-weight bearing for a while at least. Crutches are hard work. They require upper body strength. At the gym I could only do upper body work. Leg day never came. I was getting plenty of practice on crutches (lucky me) but I was also building up my strength generally and this was going to pay off. Although I wasn’t able to do any cardio work I was able to push myself with weights. Another thing that happened was that I started meeting new people. In fact I was approached on a few occasions by people saying how much they admired me for going to the gym despite being in a walker boot. This gym lark could become addictive! I found that even though sometimes I had to force myself to go (alright most times…), afterwards I felt good for it. The net result was that despite giving up golf and hardly swimming at all I managed to keep my weight steady and improved my muscle tone significantly.

I’m not telling you that you must follow me into the gym but I am saying that there is often something else that you can do when you are unable to do what you used to take for granted. Investing in your health and strength at any time is good but you now have the responsibility of a new ankle to look after. A second chance maybe. Make the most of it.