Physical Therapy and Rehab

After the cast came off, I was still not allowed to walk or put weight on my foot. My doctor recommended starting some physical therapy. I was anxious to do whatever I could to walk and get my life back again, so I went to a facility that could get me in the quickest.

I really thought I was going to go one or two times to PT then do everything on my own. But my German ancestry kicked in, and when the therapist said come back two to three times per week, I did. Basically what we started with were some foot range-of-motion exercises and some treatments, or modalities which included muscle stim, cold, laser, and deep foot tissue massage. The exercises included moving my foot up and down (or plantarflexion/dorsiflexion) 20 times, in and out (or inversion/eversion) 20 times, tracing the alphabet with my foot in the air, and some stretching by pulling a towel around my foot. I found the modality treatments to be practically worthless for me, and I also tried some other types of treatments in my clinic. I've got to admit, however, the exercises probably strengthened me faster. I also went in the pool for water therapy. I had to crawl up and down the steps into the pool before I was allowed to bear weight. For those first sessions in the pool I basically sat on the steps doing the range of motion in the water. They explained to me that the resistance of the water would enhance that exercise.

Finally, 12 weeks after surgery, I was allowed to walk on my foot. After the cast came off, I was given an orthopedic boot to wear, even though I was not to use it for walking, more for protection I guess. I didn't wear it at home, though, cause I wanted the freedom to move my foot around. On the 12th week appointment, the doctor took more x-rays, looked at my foot, and said everything looked good, and I could start walking. I sat on the examining bench, looking down at this shriveled, weak leg, and asked how I was going to do that? He just said, put one foot in front of the other, and I could use the boot to walk, and transition out of it whenever I was ready. I really didn't know how to do it, but the guy from the cast room gave me some advice. He said to use the crutches, but put my foot down, heel to toe while walking. I can't tell you how good it felt to unbend my leg, and put my foot down for walking! But how weak that leg was! I pretty much kept ditching the crutches as soon as possible. The boot was so confining I took it off for most of the time as well. I remember how I had to hold onto the bed to walk around at first. I remember I would wake up in the morning, sit on the side of the bed, stand up, and wonder, am I really going to be able to take a step? I would wobble a little, but then go forward.

I continued therapy, and it really helped. The water therapy was particularly helpful. I would continue the range of motion exercises, and would practice walking back and forth in the pool, forward and backward, placing my foot carefully heel to toe. In the water I could almost feel like I was walking normally. I did a lot of exercises: from balancing on one foot, to jumping jacks. I balanced on one foot and played catch with the therapist, I did a toe tapping exercise alternating legs, I squatted with paddles on my hands moving the water back and forth to build strength and balance. I also used flotation devices and do flutter kicks and scissor kicks. The water resistance helped build up my strength, and also helped with core muscle exercise.

I also did some exercises out of the water. Some of them I hated, in particular using a wobble board. I had to stand on this board that had a half-ball on the bottom, so I had to balance and move my feet back and forth (holding on to a bar, of course). It nearly killed me at first, my foot turned all purple and hurt so much I thought for sure the screws and plates were going to pop off! The funny thing is though, in combination with doing some exercises at home, the next few times on the wobble board I found it was getting easier to do, so even though you don't see the results right away, and you're sure these people are just sadistic, the exercises do help and make you stronger.

So how long does it take to walk normal, and maybe even go back to running? For me, it has taken a long time. I'm writing right now in December and I started bearing weight the end of June. I am still not normal. My foot feels stiff, and if I've been walking a lot, it starts to burn. I can tell it's still weaker than my left when I try to stand on one leg. It's sort of like you have to walk one mile but you're only going to move one inch a day. I used to feel like I was walking pretty normally, then at other times, I felt like I was limping pretty bad. After about three months, I felt I was doing pretty good. What happens is, you're walking along, on two feet, you hardly have a limp and you feel stronger and stronger. Sure, you have a hard time going downstairs still, and your foot hurts more after walking a while, like when you go shopping, but still, you feel pretty good. Then, you see your friend, who had a broken ankle. And you ask him how he's doing and he says he can't do a single leg heel raise on that ankle. So you try it on your good foot and can do it easily, but when you try it on your broken foot, you realize you can't raise your heel at all. And you feel terrible and discouraged all over again!

The Cast Comes Off

Every three weeks, the cast was cut off, x-rays were taken, then the cast was put back on. After six weeks, I was hoping maybe the cast could come off permanently, because the surgeon initially told me I would have the cast on six or nine weeks. Now, he did say likely nine weeks, so sure enough, I was casted again. However, I must say that my foot did look all that much better after nine weeks, a little less puffy and bruised.

It was quite a relief to get that cast off. Now mind you, I was still not to put any weight on my foot for three more weeks. Of course, my leg was all hairy and there was a tremendous amount of dead skin. There was a rather strange sensation all over my leg and foot as well, I guess it was just not used to any touch for so long. It felt good, however, to be able to rub my foot! The pain level dropped a lot also. I found I could stop taking the Vicodin, and that over-the-counter Tylenol worked okay now.

If you are lucky enough to not have to be casted, count your blessings!

My foot looked really good to me. However, when I placed my bad foot next to my good foot, I could see quite a difference. My right foot was bigger, basically, although I can't say it looked necessarily swollen, but there was swelling in the tissues just the same. There was a rather strange phenomenon also - If I put my foot down, it would get red or purplish, but almost immediately on raising my leg above my head, it returned to normal color! This gradually subsided.

Getting Mobile

Of course they sent me home with a set of crutches. After all, I was not to put any weight at all on my foot. It was weird using them. I would go a couple of "steps" okay, then I would feel unstable for a couple more steps. It was hard to hold up the painful leg with that heavy splint on it too. And there was a learning curve, such as, when using crutches on a gravel driveway, such as ours, be sure to plant them firmly before trying to swing forward, or you will fall, which I did. And negotiating steps is a real challenge, especially going downstairs. You're standing there at the top teetering on two small crutch stubs with your leg + splint suspended in air and you have to go down a step without falling. Scary! Of course there are methods, such as use the handrail and one crutch, make sure the bad foot goes down first, using your crutch with the bad foot, or you can scoot down the stairs on your butt. Also, if you wear a robe, be sure not to get the crutches tangled under your armpits! I pretty much decided the crutches were a pain and there was too much room for disaster, so I started using a wheelchair around the house to get around.

I had also seen the Roll-a-bout scooter like device for lower extremity injuries, and decided right off that was what I wanted to use. I got a prescription for it, and while I was waiting for it to be sent, I used a footstool with wheels which I happened to have quite a few of around the house. For me, I felt more stable to be able to plant my knee on the footstool and use my good leg and the knee to "walk". Plus, I could have my hands free.

I really thought I would be able to do anything and go anywhere with the freedom of the Roll-a-bout. But it really wasn't like that. In the first place, I really wanted my foot elevated as much as possible to be sure to keep the swelling down, so I had to spend more time lying around. Also my knee really started to hurt when using it on the scooter. I bought a construction grade knee pad, which helped tremendously, but still, you're just not going to go for long distances on it.

After I recovered a little from the initial surgery and casting, I attempted to drive. Of course, I could not use my right foot. Non-weight bearing means not even for driving, and anyway, I didn't have an ounce of strength, not even in the toes. So I used my left foot to drive, and it really isn't that difficult, it takes all of five minutes to get used to it. I thought I would drape my right leg over the middle console into the passenger side, but I ended up just tucking my right leg under my left while I drove.

It is such a long time to be not walking. I thought I would never be able to walk again.

Life in a Cast

The reader's got to realize first of all, I'm a 55 year old woman who never broke a bone, except for the big toe in high school, which involved treatment by wrapping it with a piece of tape. I don't even think my walking was affected by that break. Since I had no experience with a cast before, I don't know if the aggravation and pain is usual, or exceptional. If you've never had that experience either, you can read further to compare what I went through to what you're going to go through.



In a word, it is very aggravating. Whatever you do, don't get it wet. It gets even heavier, cold, and clammy. Yuck! I bought a contraption you attach to a vacuum cleaner hose to extract the moisture, but after the first experience, I never got so much as a drop of water near that cast! I also bought a plastic sleeve with a rubberized top with a hole you put your leg into for showering. It worked well, except I was too chicken to test it completely. Even though I had the sleeve on, I still kept my leg outside of the shower curtain while I was showering sitting down. Then I made sure my thigh/knee was completely dried off with a towel before I took the sleeve off.



I'm sure you've been warned about the itching. I did have a little experience with that in one part at the top of the cast near the calf (my cast was from my toes to just below my knee). Supposedly that is also due to an accumulation of moisture under the cast on the skin. I didn't have too many itching episodes because it was winter when this happened, I live in a dry climate (San Diego area), and I have extremely dry skin. That vacuum attachment was also supposed to take care of itching.



Another thing I was warned about was the smell. Your sweaty, clammy skin plus bacteria equals sort of a dirty gym locker, cheesy smell. Again, for me, that wasn't too bad, but I did notice it, and scrupulously started cleaning my exposed toes which helped eliminate that smell also.



I think the whole cast experience was worse for me because I was non-weight bearing, so I had to hold my leg up all the time. There is such aggravation! The thing is heavy, and naturally, my foot/ankle is in a constant position. Oh, to be able to move my foot! I always kept it elevated on a lot of pillows to help with the swelling, which is of itself aggravating. Then my knee was bent for so long, it started to hurt if I tried to straighten it out.

Yet, I thought I could put up with the aggravation better if it wasn't for the pain. There was an almost constant pain of some type - usually dull, achy on both sides of my ankle, sometimes the pain was very sharp, sometimes burning all around the ankle and on the bottom of my foot. Once in a while, I would have a sudden very sharp pain on the bottom of my foot like someone was driving the blade of a large screwdriver straight in. This happened so randomly, not in any apparent response to any position or activity. Sometimes, if I thought I had spent a long time sitting and lying with my leg up, I would try to take Tylenol only, no Vicodin. Ha, ha. The pain got worse. I asked the doctor if I was doing something wrong, like I should be taking a stronger dose or something, but he told me the only combination/amount of medication to take away the pain would knock me out. And since, I didn't feel any pain when I was asleep anyway, and therefore went to sleep quite often, more drugs were not the answer.

Examples of Fractured and Repaired Calcaneus

Surgery and Recovery

I guess there were options other than surgery. In fact, the doctor said if I was a smoker or diabetic, he wouldn't have operated. The calcaneus is just such a poor bone to heal. But this was such a bad break, I don't know what the outcome would've been. To me, the bone is shaped like a potato. When I landed with all my force on the bottom of the potato on concrete, it was driven up into my leg bones. The bone kind of splayed out in several pieces. So the plan was to open up the outside of my foot by the heel, and put the pieces together with plates and screws. Any space left would be filled in with bone matrix. The surgery itself generally went according to plan, although the fracture was very complex, and very difficult to manipulate and put all the pieces together.

Before the operation, I was given a nerve block in my lower leg. This was apparently a somewhat new procedure, as I was called by the hospital to let me know that was recommended and sort of asked if that's what I wanted. Well, sure, why not? As I look back on the whole thing, it was a good thing to have. Basically my lower leg was numbed.

I woke up from surgery from the one of the best sleeps I ever had. I think I even recall a dream of standing in a corridor wearing office attire. Anyway, I didn't want to be awakened. My main discomfort was my throat was sore (more than likely I had a tube down my throat). They put me in recovery in a semi-recumbant position. I was wide awake and had no pain at all. My leg was wrapped in huge ace bandage type stuff. They let my husband come in and see for a few minutes, then he left. I just lay there. I thought I should sleep because there wasn't any TV, and I didn't have my glasses to read, and anyway, there wasn't anything to read, but I was so well rested I couldn't sleep. I think I was there for 2 or 3 hours watching the screensaver on the computer monitors which just kept scrolling sentences about hospital safety tips, like "Don't block doors."

I should have mentioned the plan was for me to stay at least one night in the hospital after the operation. I learned why the doctor recommended this - the pain! The nerve block stopped the pain until about 10 am the next morning. I had a pain pump with the nerve block which I had not used, but then the pain started and I started using the pump. It really didn't seem to make a difference at that point. I told the nurses my foot was starting to hurt, they gave me some sort of IV pain med, probably morphine, which didn't really seem to help. I e-mailed the doctor, not expecting he would really respond, but he did, and the nurse gave me Percocet. I was then transferred to the orthopedic floor and given oxycontin, which settled the pain. The doctor decided I should spend another night in the hospital, and that turned out to be a wise decision.

I was told by the nurse I would get more percocet at 7:30. So before my husband left at the end of visiting hours, I asked for pain medication. When he left at 8, I asked him to remind the nurses on his way out, but by 8:30 I hadn't gotten any meds and I started getting the worst pain I have ever had in my life. Nurse then gave me daravan? iv, which slowed my respiration and made me feel like I was being weighed down on the bed, but the pain in my foot was excruciating. I was counting down the hours all night long until I thought I could take more pain medication. Nurse gave me another iv around midnight which helped but I still had very sharp, burning pain in heel. I told her, why is there that sharp pain still there? The pain on the scale of 1 to 10 was 11. I finally got another dose of percocet. The nurse figurged out the iv's didn't work and came in with a benadryl. I thought that was an allergy medication, and was slightly confused, but I finally was able to sleep. And when I sleep, I don't feel pain. I got an oxycontin dose at 4:30, woke at 6am asked for pain med, percocet. The pain was still there but somewhat settled down.

From that point on, I didn't dink around. I kept track of the time, and the time for medicine. I didn't want that pain to get a hold again. When the doctor suggested maybe I should spend another night in the hospital, I figured if I had pain prescriptions, I could probably monitor what I needed when better on my own at home.

I spent the weekend taking various pain medications within the prescribed parameters, like 1 or 2 pills, every 4 to 6 hours, trying to find the best combination, and I kept close track of how much acetaminophen I was taking so I wouldn't overdose. It was so weird. The pain was so changeable, and while I was sure to be taking at least some pain medication, nothing really made a huge difference.

After the weekend, I went back to the doctor. Everything looked stable, and I was placed in my first cast. The pain never went away. I mainly used the pain medication Vicodin, which pretty much just settled the pain down. My analogy is that when the pain was bad, it felt like my foot was in a steel leg trap. Taking Vicodin made my foot feel like it was in a vise grip instead. The next time I saw the doctor, he changed the prescription to a higher dose per tablet. I asked him why, and he said it didn't matter, so I thought maybe I had been cheating myself and not taking enough. I then took the maximum dose of the higher concentrated medicine, but you know what - it didn't make much difference. So I asked the doctor, "Am I doing something wrong here?" He told me, no, the only way to make the pain go away completely is to give me so much medicine I'd be knocked out!

I was also very naive when it came to how long the pain would last. I thought after two weeks, I'd have to take an occasional Percocet or something, and there would be no more pain. I was kind of waiting for that two week period. That was not true at all. The pain continued about the same, more or less, sometimes I could take less medicine, sometimes I had to take more. The pain really didn't substantially improve until I had the cast taken off, nine weeks later. And six months, later, there is still a level of pain.

This is an example of an x-ray of a normal calcaneus.

At First...

I thought the splint was put on wrong. The girl who put it on didn't seem too assured in what she was doing, and she put these two very hard "things" right next to the bones of my foot and a ton of cotton padding. It hurt like hell. I had to take a two hour car trip to get home, and I just couldn't wait to get home and take it off, even though the ER doctors told me not to touch it, and don't take a shower.

I did take it off, but thought I'd better leave some of the padding on, and wrapped it with an ACE bandage. The next day I realized it wasn't the splint that was causing the pain - it just hurt. I put most of the splinting back on.

Since I was dirty because I was ready to do some painting before I fell, I HAD to take a shower! I decided to keep the splint on, and my husband wrapped my leg really well, we put a stool in the shower for me to sit on, and somehow I crawled over the rim of the tub. Nothing got wet. Now the second time I took a shower, about one week later before surgery, I poo-pooed to my husband that he was putting entirely too much duct tape on the garbage bag on my leg. What a dummy. A little water got inside. A wet splint is miserable. Fortunately I didn't have to endure it too long because I went into surgery. I subsequently sponge bathed, until I ordered a dry-cast wrap. It worked well, but since I never wanted to experience a wet cast again, even with the wrap on, I sat in the tub to take a shower with my leg draped outside the tub!

After my first visit with the surgeon, I was determined to get the swelling down. I seriously made sure my leg was above my heart. I waited to get up to go to the bathroom. Before I propped my leg up, I made sure I had everything within reach. I'm a private practice doctor of chiropractic, so I had to go to the office at least a few times that week, but my husband drove, and when I was in the car, my leg was still propped up for the ride. When I got to the office, I mostly let my staff do therapy, while I charted with my let propped up on the desk, above my heart.

The pain was bad, but it seemed like it was easing somewhat during that week. I remember during the second visit to the surgeon, I hadn't taken Vicodin that morning, and asked him if I should continue to be stoic and only take it when I couldn't stand the pain anymore, but he told me for crying out loud, you broke a bone - take it when you need it!

The assistant in the cast room took the splint off. My foot was all purple and looked swollen to me, but not near as bad as the week before. I didn't know if it was good enough. The doctor came in and immediately remarked on how much better it was, and we were ready to go! Of course, scheduling for surgery is not immediate. There are CAT scans to obtain, surgery suites to be available, pre-op screening/testing, etc.

All requirements were met, the date was set, I was good to go.

Fall From Normal

It's been a long time since I relived the fall. I used to go through it in my mind at least once per day. I was on a simple stepladder, on the third or fourth step, about 4 or 5 feet off the ground. I just needed to get up on the next step. But when I lifted my foot, the ladder started to tip and threw me off of it. I threw my arm out trying to find something to grip onto, and then landed on the concrete on my right heel. My foot/ankle hurt, but I've sprained an ankle before. I sat on the ground hoping against hope nothing was broken. I had felt the force on my heel so I felt around it and it felt intact, but it hurt a lot.

My husband and stepson came over, and wanted to get me up. I thought my ankle was hurt pretty bad, so I told them we better get to urgent care or emergency for an x-ray, cause you just never know without an x-ray. Man did my foot hurt!

After x-ray, the orthopedic doctors on call came in. They said it was a broken heel bone, I'd need surgery, and have to stay off of it for 12 weeks, but they didn't really know for sure because they weren't foot specialists. For now, go home (because it happened out of town), keep the foot above my heart, make an appointment for Monday with either an orthopedic surgeon or a podiatrist. In the end, I sure was glad I called a foot surgeon. This break was so bad there was no way...anyway

I didn't believe it. I went home and hoped it wasn't that bad. Yeah, I spent the rest of the weekend with my foot up on a few pillows with the splint on. I got up as little as possible, used the crutches of course. I usually don't get hurt. I do things, but if anything happens, it's usually minor and I recover very fast.

By the time I got to the foot surgeon's office Monday afternoon, my foot was very swollen. It was the worst case scenario. Smashed heel bone, surgery as soon as possible, then absolutely no weight bearing for 12 weeks afterward. But the swelling would have to come down. If it didn't, surgery would be delayed. Wow, was this ever hard to accept. First of all, my life would have to stop. When they said foot above heart level, they meant it. No getting up, no walking, much less driving. And thank God we have a house without steps. Ah, yes steps - I never knew how daunting they could be with only one foot/leg.

My heart just sank. I looked down, I looked at my husband, I just thought and probably said, well I'll do what I have to do.

Thus began a journey longer than I ever thought was going to be necessary. A journey of healing, rehabbing, trying to get my life, ME, back. A journey I'm still taking...