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Physical Therapy: It Comes with a Crush

The first couple of times I asked my surgeon about physical therapy, he said it wasn't necessary.  He was quite definitive: "You don't need physical therapy."  At my three month follow-up, after telling him I was frustrated with my inability to walk correctly, he finally gave me a prescription for PT in order to improve my gait.  My first appointment was today, and by the first five minutes I developed a crush on my therapist.



It isn't a romantic crush (although he is very cute): it is a crush on someone who listened to me and responded to my concerns, hopes, and questions.  Here he is in an introductory video on YouTube. (Click on the name below the photo.)


After brief introductions, it was clear that he read my chart.  He asked me if I walked my daughter down the aisle at her wedding (one of my goals before surgery).  He told me how great it is that I travel.  He was talking to me face-to-face without a computer in sight.  Can you understand the developing crush? 

My doctor didn't recommend a particular physical therapist, but I decided to use Duke Physical and Occupational Therapy at the same office on Creekstone Drive.  My reasoning was that if the top ankle replacement surgeons were in the same office, they must work with a lot of post-surgical ankle arthroplasty and subtaler fusion patients. I was concerned since a couple of my friends had told me that they asked their physical therapist about an ankle replacement, and they knew little, if anything, about the procedure.  My instincts proved true: Stephen has worked with a large number of post-ankle replacements. 

The appointment began with some measurements.  I can only flex my right ankle 5 degrees; normal is like my left ankle that bends 20 degrees.  He watched me walk and explained that I am toeing out; my stiff ankle is telling my brain that it is more comfortable to walk with my foot angling right, and it continues to send messages to my ankle in order to prevent pain.  The goal is to increase the flexibility of the ankle and get the brain to keep my right toe going forward.  

In order to do that he has given me four exercises to do at home:

ANKLE ABC's 
While in a seated position, write out the alphabet in the air with your big toes. Your ankle should be moving as you perform this. I am supposed to do one set three times a day.

ANKLE DORSIFLEXION STRETCH
Standing with one leg on step. Using leg that is straight, push already bent knee further forwards. I don't have any stairs, so he told me to use my step stool, placing it against the wall and trying to reach the wall with my knee.  Repeat 10 times, holding it for 10 seconds, two times a day,

 TOWEL SCRUNCH
Place towel on hard surface. Begin with the foot flat on the floor. Keeping the heel on the floor, repetitively "scrunch up" the towel by curling your toes. Each repetition of toe curling is one repetition. Attempt to bunch up the towel under the foot.  This was more fun with Stephen since we played tug of war with the towel.  I am not sure just how much Zora is going to let me do this one, or, at least, she will play tug of war with me. I am supposed to do three sets of 20 scrunches two times a day.


 STANDING HEEL RAISES


After trying unsuccessfully to flex my ankle enough to have my knee reach the wall, we were walking back to the table, and I saw another woman standing on her toes, moving up and down.  I didn't think I could do that and asked Stephen if he thought I could.  He said that was just what we are going to work on now.  While standing, I need raise up on my toes as I lift my heels off the ground. I was totally surprised that it was not a difficult exercise for me to do, certainly nothing like the ankle dorsiflexion. At home, I am supposed to repeat the standing heel raise 10 times, holding it one second, doing this for 2 sets, 2 times a day.

I created a spreadsheet (some people call me the queen of spreadsheets, although I do not hold a candle to my dear friend, Susan) to keep track of the exercises, giving me a little accountability.
ExercisesAnkle ABC'sAnkle ABC'sAnkle ABC'sDorsiflexionDorsiflexionTowel scrunchTowel ScrunchHeel RaisesHeel Raises
123121212
Monday7/9
Tuesday7/10
Wednesday7/11
Thursday7/12
Friday7/13
Saturday7/14
Sunday7/15
Monday7/16
Tuesday7/17
Wednesday7/18
At the end of the appointment, about 45 minutes later, I asked Stephen the plan.  He said he wants me to come once a week for three weeks; each week he will reassess my progress.  Most of the work has to be me.  He also agreed with Dr. Nunley that walking is good, but not all at one time.  He said the idea is to walk or exercise, not to the point of hurting for two days like I did last week.  Then rest and go walk and exercise more until the periods of rest get shorter and the walking and exercise gets longer.  I also asked about the nature trail I use for walking Zora since some of my friends thought it might not be the best terrain for me; he said that there was no reason not to walk the uneven, soft path.  Finally, based on his recommendation, I put water aerobics on my schedule three days a week. Maybe if it's on my calendar, I'll go.  The next step is following through with the work. Perhaps my crush will keep me from disappointing him.

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