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
Despite the fact that she could not walk and needed to be sitting with her foot elevated most of the time to keep the pain under control, Mia Rose was back in the gym doing conditioning and some bars just 5 days after surgery. Thisvideowas taken just 8 days after surgery as she was learning how to do bar skills with the weight of a cast on her foot (she put an ankle weight on the other side for balance). After a while on bars the first few weeks she had more discomfort in her foot, but not enough to cause problems, and she would elevate after that by walking on her hands and doing handstands…aka getting her foot as far above her heart as you can get.
Initially she was at the gym for just two hours a day, but within a couple of weeks she was staying for the full practice and started lifting some weights as well. Despite the fact that she still needed a lot of help with every day tasks at home like getting food and drinks and showering, at the gym she was able to feel a little more independent and “normal.” She was absolutely determined not to lose any strength and to be ready to jump right back in to competing as soon as her foot healed (in 4-5 months), so she knew that she needed to put in the time and hard work to stay strong.
As crazy as it sounds all of the time in the gym really helped to keep her sane during a very difficult time. Competing and being at the gym training and working along side her teammates has always been where she is happiest, so that was where she wanted to be as she recovered. In the gym she was able to do something productive and keep her mind on things other than being sad and in pain.
Throughout her recovery she used a combination of the iWalk 2.0 and crutches depending on where she was and what she was doing. The iWalk was great for making it possible to hold things while moving about and helping to keep her quad and glutes active on the left side, but in the first month post surgery she could only use it for short periods because the jostling of her foot would cause increased pain and swelling. In the gym crutches were more functional because of the uneven surfaces and the fact that she could put them down and pick them up quickly.
November 21, 2016: Four days after surgery, Mia Rose had her first post-op visit with the surgeon. At that point she no longer needed the percocet and was able to manage the pain with Aleve, which she only took for a couple of days after that. Although she was not pain free, she really disliked taking the meds and like many gymnasts, she has a high pain tolerance so she was happier medication free and I think that being fully aware of what increased her pain helped her to chose her activities more appropriately than if the pain had been blunted by drugs.
The surgeon took x-rays to confirm that everything was as it should be, and it was, and then put her in a hard cast to protect her foot as it healed. She was not thrilled with the color of the cast (orange) and when asked said that she preferred blue, but they didn’t have that so orange was it.
She was given orders to remain on crutches *strictly* non-weight bearing and to elevate her foot as much as needed to control the pain and swelling. We also asked about using the iWalk (aka “peg leg”) instead of crutches so that she would be able to have her hands free and keep her leg and glute muscles more active while she was recovering and the surgeon said that was fine.
One good thing was that the surgeon told her she could swing bars as long as she was absolutely certain that her foot never touched the ground. He also told her that she should keep her conditioning up throughout her recovery. Armed with that information we stopped by the gym on the way home from the doctor to say hello and update her coaches, but she opted not to go to practice until the next day.
The nerve block wore off after about 12 hours at which point the pain in her foot was intense and she definitely needed the percocet that the doctor had prescribed. While she was grateful for the pain relief she really did not enjoy the way it dulled her thinking or made her queasy so she was anxious to get off of it as soon as possible. Thankfully she only needed to take them consistently for three days.
She spent a lot of time in her dad’s recliner with her foot propped up an lots of pillows which helped to keep the pain and swelling controlled. Cuddles from her kitties and lots of good books were her preferred distractions though there was plenty of television in the mix too.
Friends and family were incredibly sweet and supportive, she had lots of visitors, cards and phone calls which really helped to get her through.
November 17 was surgery day. The surgery lasted about 90 minutes though we were at the hospital for about 9 hours because of a 4 hour delay getting her into the OR. She had not been able to eat after midnight…so it was a very long and hungry day for her. The surgery went well and the surgeon was able to get all of the bones properly aligned which is the most important thing for proper healing. The anesthesia made Mia Rose rather sick, so getting through that was rough. But once she stopped vomiting and had a short nap in the car on the way home, she was feeling pretty good and was ravenous. They did a nerve block to numb her leg from the knee down during surgery, so once she was awake she had no pain and thoroughly enjoyed her dinner.
We saw the first orthopedist on November 10th and she was immediately suspicious that Mia Rose had sustained a lisfranc injury. She ordered a weight bearing x-ray, meaning that Mia Rose had to stand on her injured foot while they took the x-ray (not fun). Ten minutes later the doctor showed us the x-ray you see here and explained that it indicated an unstable lisfranc injury with a 2 mm separation and that surgery was required. She said that the lisfranc ligament was torn which was what allowed the bones to dislocate and that in order for the ligament to heal the bones had to be put back in perfect alignment and kept that way with screws. This was devastating news for Mia Rose who was getting ready to head into her competition season with the expectation of a great season.
We saw two additional orthopedic surgeons over the next few days to make sure that the diagnosis was correct and surgery was truly necessary. All three shared the same diagnosis and need for surgery with us. We opted to go with a surgeon who had the most experience with this injury and with treating gymnasts including Olympians and national team members.
The doctor we selected, explained that during the surgery he would remove any bone fragments that were in the area and insert anywhere from 1-5 screws as needed to stabilize all of the joints that were unstable from the injury. He said that during surgery he would be able to determine exactly which joints were injured so that everything could be put back in perfect alignment in order for the ligaments to heal. He explained that after surgery Mia Rose would need to be 100% non-weight bearing in a hard cast for at least 6 weeks and then immobilized in an orthopedic boot with progressive weight bearing for an additional 4-6 weeks. He also explained that after 3 months she would need to have a second surgery to remove the screws and that she would not be able to do any impact activities such as running or jumping until after the screws were removed because of the risk of the screws breaking from impact.
We scheduled the surgery for later that week so that she could get on the road to recovery as quickly as possible.