Mia Rose’s first full week without hardware in her foot was a good one. She she only needed tylenol briefly and no pain meds at all after that and each day she felt a little better, was off the crutches after just a couple of days. She saw her PT on Monday and everything looked good. She’s graduated to more advanced exercises focused on building more sports-specific strength and balance. As a gymnast she needs to develop a lot of muscular strength to support her feet from within since she trains and competes barefoot.
Between PT, gymnastics practice and the ARP Wave work she’s doing at home every day, the atrophy in her left leg is disappearing quickly. Yesterday,exactly 1 week post screw removal and 13 weeks post ORIF, her left calf and quad measured only 1/4 inch smaller than her right. She still has a way to go, but considering that the calf looked like skin and bone when she got out of the boot and the quad was much smaller than the right one, that’s impressive. She is already able to get up on tiptoe on her recovering foot, not always easy after this injury, but critical for women’s artistic gymnastics. She’s also starting to do some additional skills in the gym. She says that her foot is feeling better with the increased movement and light impact activities. She has no pain at all in the lisfranc area…just some muscle soreness in her foot and ankle as she is now using the muscles far more than she has in months. Riding in the car makes it a little stiff but that quickly resolves once she gets out and moves.
The best thing today was that when I walked into the gym to pick her up, both of her coaches stopped me to tell me about skills that she did today for the first time since her injury and commented on how quickly she is coming back now that the hardware is out. The also commented on what a great job she has done at keeping herself strong through this long recovery. They were clearly proud of her and it was really nice to have them share that with me. Such a nice way to end what was a challenging week for me in other areas.
Mia Rose is feeling very good considering she had surgery just yesterday. For anyone who is wondering what the lisfranc hardware removal surgery recovery is like…it is *much* easier than the lisfranc ORIF surgery! Extra strength tylenol and elevation have been all she needs to manage it. The incisions are sore but not terrible. The front of her ankle is also sore…we’re guessing from the position they had her foot in while they were removing the hardware. But she is able to use her foot without increased pain which is great.
She’s been using the ARP Wave machine lots since the surgery to help accelerate her recovery. Right now it is set for recovery. Next week she will move back into the rehab protocols to help rebuild lost muscle and improve neuromuscular patterns in order to help prevent future injuries. We are really hoping that adding this to the rest of her rehab will make a difference in both the long and short term.
Today is the beginning of the final phase of this recovery process. Mia Rose’s hardware is coming out! It has been 12 long weeks to the day for her. (Even though we know that many have hardware for much longer, it has felt like an eternity to her).
While she was not looking forward to another IV, post-op nausea, or incision healing process, she is *really* looking forward to being allowed to do more impact and sports-specific rehab in the near future. I will update this once she’s out of surgery. (I’m in the same day surgery waiting room as I write this.)
Surgery went very well. The surgeon confirmed that all of the joints were stable after he removed the screws which is what needed to happen. Before the surgery we told the anesthesiologist that she woke up vomiting and miserable last time and he promised to try to make adjustments to help minimize that to the extent possible this time. The great news is that it worked! By the time we got to see her, she was sitting up smiling and ready to leave, an entirely different experience than the last time. She had no trouble keeping down the ginger ale they gave her as soon as she woke up and within 20 minutes she was happily gobbling down the container of mixed berries that we had gotten for her in the cafeteria. No nausea at all and far less groggy that the first time around!
She had some soreness but no serious pain in her foot. After getting some breakfast I took her over to the gym so she could see her coach and team mates for a few minutes and then headed back home to snuggle into the recliner with her foot up.
This was a tough week of ups and downs. Mia Rose did a great job of getting her full bar routine competition ready and showing her coach full routines every day at practice (minus a dismount since she is still not allowed to land on her foot). Showing full routines every day this week was required for all of the athletes who are going to compete at a meet in Las Vegas next weekend. She was very excited to have put her full routine together in time for the Las Vegas meet after having to miss 6-10 weeks of training several of her most difficult skills after surgery. We had all (including her coach) thought that Mia Rose would be competing bars in Las Vegas with layout to her back for a dismount. Unfortunately, the head coach of the entire program told her regular coach that she cannot compete without a doctor’s note clearing her to land. Since the screws are still in her foot, we are not able to get that. Mia Rose was heartbroken since not only did that mean she can’t compete, but it also meant that our trip to Las Vegas with her teammates, that she has been looking forward to all year, was not going to happen. It was nice to see how much her coach wanted her to be able to compete…he commented “she’s worked so hard and deserves to be able to show what she’s done” and did everything he could to make it possible for her to compete, but it seems there is a rule in place that simply won’t allow it.
The very important silver lining is that because we will not be traveling, we were able to move up her hardware removal surgery date. Her surgeon will now be removing her screws on February 9th, instead of the 16th. Which means that she will be recovered from the second surgery and able to do more in the gym a week sooner than she would have been. So we’re focusing on that and the opportunities that it provides. The extra month to polish her bar routine before she competes it will make it even prettier than it is now too.
The other big thing that happened this week is that the ARPwave system that the doctor prescribed to try to help resolve the “disuse atrophy” that she has in her left leg because of being immobilize for so long arrived and she did her first treatment with yesterday. The treatment phase is very uncomfortable but the recovery phase felt good. With any luck this will help her to get her strength back more quickly on the left side, and it is also supposed to help correct any imbalances that could contribute to injury in the future. This is in addition to all of the work that she’s doing in PT and at the gym.
Here’s hoping that next week is free of negative surprises and that the screw removal surgery is as quick and uneventful as the doctor expects. We are looking forward to being in the next phase of the recovery process very soon.
Today was Mia Rose’s first visit to the PT since she started wearing the sneakers and orthotics. She had a good session, got new exercises to work on her own (squats single leg and two leg, RDLs, big toe exercises to get some of the small muscles in her arch more active etc), and got instruction in how to correct her gait so that she is now walking with much less of a limp. She had been walking in the boot for so long her steps had become short and choppy with a bit of a swing from the hip on the left side. Her PT told her to take longer steps really focusing on squeezing her glutes with each step and leading with the front of her hips. Within just a few seconds that dramatically improved her gait and reduced her limp to almost nothing. I will try to grab video later today to show the difference.
Physically Mia Rose is doing extremely well with her injury healing ahead of the typical timeline. She has little to no pain even when she is up and about doing lots, and the rest of her body is stronger than ever. But, since the purpose of creating this blog is to help others who are traveling this road to recovery from a lisfranc injury, I can’t just talk about what is going so well…I have to acknowledge that mentally and emotionally this has been a grueling process to say the least.
We are both pretty exhausted by the seemingly never ending medical appointments between PT, follow-ups with the surgeon, and visits to the chiropractor to address back pain from being on crutches and then walking in the boot for many weeks. We are typically going to 3 appointments a week to some combination of medical professionals. Both of us are very anxious to get to the point where she will not have such frequent visits! Between the medical visits, her schoolwork, my job, and her practices it feels like we never stop and the injury and recovery process are constantly front and center in our life. After the screws are removed on February 16th, I’m hoping that things will settle down quite a bit in that regard. Although the long term big picture seems to look very positive at this point, in the day to day it can be difficult to stay positive. It is definitely a daily (sometimes hourly especially early on) conscious choice to stay positive and focus on how far she has come in the past 11 weeks. When we look at her progress it is easier to appreciate how well she is doing. We have daily conversations about the little things that are better each day to help us really see and focus on what it good. Early on that was things like going 5 hours without needing a pain killer instead of 4 the day before. Now it is things like being able to dramatically reduce her limp with just a small change from the PT, being able to do one more leg lift or connecting one more skill in her bar routine for the first time since she got injured. I highly recommend doing this as it helps you to focus on the positives that are there but could easily go unnoticed and being able to see progress is so important to knowing that you really are recovering.
All of that said, we continue to take the long view and know that everything she is doing now (and everything she is not doing per doctor’s orders) will ultimately lead to her being fully healed with her foot ready to support her for a lifetime and with her back to the sport she loves while also being stronger than ever. That’s the”sliver lining” that we focus on and are grateful for every day.
On Jan 25th Mia Rose had another appointment with the surgeon when we were supposed to pick up her orthotics, but they had not arrived yet.
Her surgeon twisted, bent and poked at her foot even more intensely that two weeks before and again she had no pain at all (sat completely relaxed as he manipulated it), which elicited the remark “amazing” from him…he said it more to himself than to us, but clearly feeling so good and moving so well 10 weeks post surgery is not typical. He then told us we could schedule surgery to remove the screws in 2-3 weeks. We scheduled that for February 16th (exactly 13 weeks after the initial ORIF surgery).
On January 26th her surgeon’s assistant was very kind to bring her orthotics to us, since he lives in our area while the surgeon’s office is nearly an hour from our house. He put the orthotics in her sneakers and said that she should gradually break them in starting with one hour and increasing each day. Here’s a VIDEO of her first steps in a sneaker since the injury on November 9th.
VIDEO: Working her switch leap was the first thing she wanted to do when she got into her shoes…since she takes off and lands on her uninjured foot she was able to do it without a problem.
Although she still has a limp, she’s comfortable in the sneakers and so happy to be moving away from the boot. We’re looking forward to seeing her PT tomorrow.
January has been a busy month with lots of physical therapy, doctors visits and gymnastics practice.
Mia Rose has gotten most of her skills back on bars and is focused on trying to be ready to compete bars in February. VIDEO In addition to practice where she does bars plus tons of conditioning, she does PT once a week with our fantastic PT who is very well versed in gymnastics, home exercises prescribed by her PT daily, another hour of PT once a week with a trainer and lifts weights several days a week with me. She is really determined to be even stronger than she was before when she is cleared to get back to gymnastics fully.
She saw the surgeon on January 11th and he took more x-rays, which looked good. He also moved her foot around and pushed on the arch a bunch, which happily didn’t hurt her at all. He seemed satisfied with her progress and took molds for custom orthotics for her sneakers at that visit as well. We will be traveling on February 9th and the goal is to have her comfortably walking in her sneakers before then.
On Christmas Day Mia Rose tried putting weight on her foot for the first time in 6 weeks…and amazingly it did not hurt at all. She was so happy…quite a wonderful Christmas gift. Over the next few days she was able to give up her crutches completely without any pain at all other than irritation to her shin from the top if the boot.
She had her initial physical therapy evaluation two days before and her range of motion and strength were quite good for the circumstances and her PT gave her range of motion exercise to do at home until her next appointment. She was very pleased to be able to move and begin to work on getting her range of motion back.
At this visit Mia Rose’s cast was removed and she was put into a walking boot, but the doctor told her that she needed to remain non-weight bearing for one more week. After that he told her that she could begin weight bearing in the boot as tolerated. He said that she could walk as much as she could reasonably tolerate. He said that some discomfort was to be expected but intense pain was not. He also said that she could ditch the crutches as soon as she felt ready.
As expected her foot and leg were pretty flaky and in need of a good scrubbing when the cast came off and the atrophy in her calf was pretty extreme as well. She was bummed to see that but looking forward to starting PT to begin to build her strength back up. Despite being a little stiff from being immobilized for 5 weeks, she had pretty good range of motion in her ankle and said it felt really good to be able to move it. The doctor said that she could remove the boot whenever she was sitting to do range of motion exercises.
Two weeks post surgery Mia Rose saw her surgeon to have the incisions checked and a new cast put on her foot. They took the steri strips off of the incisions (but did not touch or clean them so they looked pretty gross). Her doctor was pleased with the amount of healing that had taken place and there was no sign of infection. Mia Rose was extremely happy to be able to move her ankle for a few minutes between casts and had good range of motion. She was also shocked by how much her calf muscle had atrophied with just two weeks of complete immobilization.
Here’s some VIDEOof the “basics” Mia Rose was able to do on floor to help her keep strong while 100% non weight bearing on her left foot.
Just before this visit she had started to experience periodic “electric shock” sensations in her foot which were both jarring and seemed worrisome to us. It turned out that as miserable as they were, those sensations are very normal as the nerves begin to “wake up as the inflammation goes down. I’m sharing that here, because it is very