Thank you for your help.
Dr Blake's Response:
You are in the 3 month zone of the surgeon's responsibility before they release their patients back to people like me who will rehabilitate. Everything I discuss has to be discussed and agreed upon by your surgeon who has ultimate responsibility and first hand knowledge. My primary goal here will be to give your some normal guidelines on what happens and can be done.
After you leave the hospital or surgical center, you will have bandages and stitches and post op shoes/boots, and crutches. These will all be in part of your life until 2 or 3 weeks when the wound has healed and your stitches can come out. The joint is sore, swollen, very limited range of motion, and basically non functional at this point. The next 10-12 weeks you have to reverse all the swelling accumulation with icing twice daily, NSAIDs, contrast bathing each evening, and 2-3 times per week physical therapy. This is where you are at right now. Your goal the next 8-10 weeks is to reduce swelling, but get strong.
So, during this next 8-10 weeks, use crutches, removable boots, post op shoes, big tennis shoes and orthotics, whatever it takes to minimize the day to day irritation that will keep aggravating the swelling. You want 2 months from now to be in a great position to re-strengthen the foot and leg. The Immobilization Phase (now for you) lasts typically 3 months, and the Restrengthening Phase until your 1 year Anniversary. Don't let the inflammation linger into the 4th month by pushing it too much now.
The physical therapist goal in seeing you is to reduce inflammation, gradually increase range of motion, gradually teach you how to strengthen your whole lower extremity progressively, sometimes design dancer's pads and/or orthotics, make recommendations to the surgeon on your progress and changes in treatment, etc.
After the 12th week post operatively, typically the swelling is down, the range of motion is better, and the Restrengthening and Return to Activity Phases are gradually blended. Some activities will take you 1 full year to get back to like cutting hard in basketball, whereas running with off weighting orthotic devices can be started at 3-6 months. Depends on the force needed for the activity.
It is important to understand about scar tissue maturation. At 9 months, the scar tissue produced by the surgery will begin to thin, and cause less interference with normal motion. By 12 months, the scar tissue is typically no longer a problem restricting motion and causing pain. Some activities require this normal scar maturation process to occur before they are comfortable.
So, in my practice, you would have the stitches removed, you would have little to no pain because you would be using crutches, removable boots, etc, whatever is needed, you would be icing 2 times a day, contrast bathing once daily, you would be going to PT 2-3 times weekly, you would have a healthy diet, you would be getting soft based orthotics (like Hannafords) to protect the joint, using dancer's pads (1/8th adhesive felt from mooremedical.com), you would use spica taping when you feel you need it, you would be using the Blaine Scar Kit for twice daily massage, and the physical therapist would definitely have you on the stationary bike (arch on the pedal), swimming/running in place in the pool, taking NSAIDs orally or topically, doing Hallux Limitus Self Mob if allowed twice daily, walking progressively more and more, not trying to manually increase normal joint motion, and using intelligent activity modification principles. Memorize my post on Good vs Bad Pain.
I sure hope this helps some. Rich
