Q&A

WEIGHT-BEARING/WALKING

When did you start weight-bearing?

7.5 weeks after surgery. According to my doc, a typical range is 2-8 weeks, depending on the type of fracture and healing process.

Did it hurt when you started weight-bearing?

I wouldn’t say I had PAIN pain — more like sore muscles, weird tingling, pressure, and unfamiliar sensations. As well as some swelling, so icing/elevating was key! But any pain or weirdness was definitely overshadowed by the joys of being able to practice and make progress!

Was weight-bearing a progression or did you just start?

It was completely a progression for me, as instructed by my PT. My phases were:

• The boot + 2 crutches

• The boot + 1 crutch

• The boot and no crutches

• Then it was time to take the boot off and I brought the crutches back for 2 sneakers + 2 crutches

• 2 sneakers + 1 crutch

• And then I was fully weaned off the boot and the crutches and just had two sneakers

I spent about 3-5 days in each phase.

How do I get past my phobia/anxiety of starting to walk again?

There's not one answer for that. In my experience, once the doctor/PT has says it's ok, you just have to start. It's hard and scary, and you might doubt yourself or find it hard to trust your instincts, but go slow and have patience with yourself. You'll get there.

Did you have a limp?

I didn't limp, but that's not because I couldn't have. My PT told me early on that if I feel the need to limp, then I'm doing too much — meaning, that I should go back to the previous stage in my progression. My PT said that limps can become habitual, so just don't ever start.

When you were learning how to walk again, how long did you practice each day? How often?

I didn't have a set amount of time or cadence. I walked as much as I could indoors — around my apartment and around the carpeted hallways of the building. I went for as long as I could until I felt like I’d challenged myself enough, then I’d stop and ice/elevate. Maybe one session was it for the day, or maybe I rested and then went a few more times. It also totally depended on which stage I was at in the progression — those early days of bearing weight had me breaking a sweat in like 5 minutes. In my experience, the most active I could be without over-doing it, the better. And there might be some days when maybe you push too much, that’s ok, just rest and ice even more. It's good to play with your limits.

I’m not weight bearing yet, and my foot turns blue/purple when it’s not elevated, then goes back to normal when I elevate again. Is this normal?

Ha! It is normal! Gross and painful, but normal. At least it was for me, and many others who have reached out to me. A non-doctor’s explanation is that is has something to do with blood flow, and when you’re not walking or putting pressure on the muscles down there, the blood just sort of pools and stagnates. I also asked Dr. Gellman about this in our interview and he shared more detail. Don’t worry, it fixes itself when you start weight-bearing. But if you’re concerned definitely call your doc.

How many months before you started walking normally?

“Normal” is a spectrum and can mean a bunch of different things — it’s not like one day you’re walking weirdly and the next day it’s normal. It took about a month from when I started practicing walking for it to LOOK normal, but it didn’t feel normal for a while. At about 6 months post-op is when I started to FEEL more normal walking, and at 1 year/18 months I mostly didn’t think about it anymore.

How long did it take you to walk up and down stairs?

Because of the building I lived in, I was going up and down stairs from the beginning while I was freshly on crutches (carefully, because it definitely takes coordination!). Once I got rid of the crutches, stairs were definitely hardest to tackle but I used them as part of my walking practice. Going up stairs was relatively easy to cheat because I could avoid putting all the pressure on the healing foot by leading with the other one. But to cheat going down wasn’t possible — it either required leading with the injured foot, or leading with the other but having good range of motion in the achilles of the injured foot. So getting comfortable going downstairs definitely took more time. Stairs were sort of the last frontier to tackle, even after I was in two sneakers.

How long did it take you to be able to walk down stairs with your bad leg taking the first step? My dorsiflexion feels like it will never come back.

First of all, don’t call it a bad leg! It’s healing for you and that’s so, so good of it. That said, it definitely takes time to be comfortable with regular walking/pressure on that foot before leading with it on stairs — I was definitely in 2 sneakers by that point. It takes practice, trust, and mobility. For the dorsiflexion issue, take a few mins each day to walk up and down stairs slowly. I also highly recommend massage to work on that achilles and calf.

Did your ankle start swelling again when you started walking?

It sure did, nothing a little ice and a compression sock couldn’t control though. But it’s a good thing! It means new muscles and parts of your ankle are working and blood is flowing. If you’re concerned though, call your doc/PT.

PAIN, TIGHTNESS, AND WEIRD SENSATIONS

Did your ankle ever stiffen up and not want to move? How did you work out the stiffness and tightening?

Of course! (and uhhh it still does 8 years later, which is why I have my chiropractor adjust it every 6 months or so). When I first started bearing weight, I would stay in bed after waking up and start the day by self-massaging my angle, foot, and calf. I just kept coconut oil and shea butter right beside my bed and it worked great. You can also go get professional massages, which I did — and also YOGA YOGA YOGA. Stay as mobile as you possibly, safely can.

I can't feel the top of my foot. Like at all. My doctor assures me that sensation will return, but I'm afraid there's nerve damage. Also, since I've been weight-bearing I'm now having some moderate ankle pain, kind of like a headache in my bone and shooting, electrical-type pains through my foot. Hoping this is all a normal part of the healing process.

Ok, I have no idea about your specific pains and issues, but I have a few thoughts:

• If you’re worried but your doc says something ok and you feel otherwise, there’s no harm in getting a second opinion. In fact, I highly recommend a second opinion on everything!!

• HOWEVER, I had so many of the same issues. And they varied from day to day. Sharp nerve pains, dull bone aches, tight muscle pulling pain. Being immobilized creates so many weird sensations, and then starting to walk again creates them too. I found that walking, massage, and stretching regularly all helped to work through those issues. It was almost as if your systems got all un-wired during surgery, and now your body is setting about the task of re-wiring. But again, if you’re worried, seek out professional help from somebody who you trust and will listen to you.

I am completely unable to point my toes, my foot just wont bend that way at all. I'm going to talk to the surgeon this week about removing the hardware as it seems that patients can get better movement back this way.

It’s possible that removing the hardware will give you more range of motion. But you also have to actively re-train your feet, they won’t just naturally go back to how they were — it’s your job to make them. Yoga. Toe spreaders. Massage.

I randomly have a lot of pain in my heel. Also I feel like the boot rubs over the incision site. Did you have that? Hope did you cope?

I definitely had heel pain at times, and massage helped a lot! Massage helped with incision pain too (scar massage is so key!) once it was healed enough.

How did massage help you?

The massage helped to break up the scare tissue and relax my very tight muscles after they had been immobilized for so long. And it wasn’t just my feet/ankle/heel/achilles/calf. It was my shoulders from crutching, my other leg and glute from over-compensating, etc. Also, massage was used in combo with all the other stuff (ice, elevation, stretching) which is key. There’s also really fascinating stuff to learn about massage and how it helps based on how muscles heal and recover — definitely worth listening to it first hand from Ashley.

RETURN TO NORMALCY

How long until you started to feel normal?

I know this isn’t what you want to hear, but recovery — normalcy — is a journey, not a destination. You don’t go from being “not normal” to being “normal” from one day to the next. That said, I realized at about 4-5 months post-op that I was doing “normal things” – I had a social life, I could walk for longer and longer, and I traveled on a plane for the first time. But I still required tons of maintenance. I still had bouts of swelling, setbacks, weird aches and pains, etc. It’s not a linear path. Even at 8 years post-op, I still get a tight foot that I need to get massaged or use my toe spreaders.

When did you go back to work?

About 3-4 months post-op.

When did you start driving?

I started driving shortly after I was walking in two sneakers — about 3-4 months post-op, right before I went back to work.

WORKING OUT

Did you experience muscle atrophy? What did you do about it?

Sure did. Here’s what I did about it.

When did you start exercising?

This wasn’t a “start” activity in the way you may be thinking about it. I started going to PT at around 1 month post-op, where my first physical activity was 6 minutes at a time on the recumbent bike (and I was at 15-minute intervals by the time I was done). Then I moved from PT to Pilates which was very low impact and mostly focused on stretching, strengthening, and articulating my feet and legs. I did my first spinning class (carefully) at 5 months post-op (according to my surgeon, it may be ok to start spinning again as early as 4 weeks post-op), I started doing barre videos at home at 6 months post-op, and though I had been doing yoga at home for a while, I went to my first yoga class at nearly 7 months post-op.

It would be nice to hear what type of exercise you have done to gain strength and flexibility on your foot/leg again?

Yoga, yoga, walking, yoga, and walking. Those were the best things for me. I also STRONGLY recommend ankle and foot massage from somebody who really knows what they're doing. It helps with circulation and also to get those muscles loose.

When did you start jumping (jumping jacks, jump rope)?

I’m not a big jumper in general, but I do recall doing so about 2 years post-op — I probably could have done it sooner though.

Are there any exercises that you still can’t do?

The only place I still notice a difference is in my range of motion for single leg squats. I still notice easier balance and easier movement on one side. Also, this isn’t an exercise, but I notice that when I lie on my back and put my feet on the wall with my knees bent, the foot on my injured side doesn’t rest as flat against the wall as my other foot.

THE BOOT & SHOES

Did you sleep with the boot on?

My surgeon left it up to me. I didn't sleep with the boot on, it was too uncomfortable! Especially in the early stages when I still lacked major range of motion. I slept with it elevated on a bunch of pillows for a really long time, until I figured out how to use pillows to support my ankle in other positions on my side and belly.  

Did you always wear your boot (while elevating, sleeping, etc) or only while walking?

I mostly just kept it on when walking. When I was in bed or hanging around the house and not weight-bearing, I kept it off.

Is the walking boot necessary after cast removal?

Mine was indicated by my surgeon and physical therapist — but I don't think anything is necessary across the board. Depends on your situation.

Where did you buy your boot?

My surgeon provided it through an orthotics company.

What brand is your boot?

No clue! Whatever your surgeon gives you should be good, or you can check out a medical supply/orthotics place.

When were you able to start wearing heels?

It took me a while to feel comfortable, but really once I was comfortable with it, I had no need to wear heels. I think I probably would have done so confidently at about 1.5 years? 

What are the best shoes to wear with the boot when you start weight bearing? The shoes for your non-injured foot?

It’s tricky because it has to have a little lift so you’re not lopsided with the boot! But it also has to be cushy and not rub on the incision/scar. My favorite was the Roshe — super soft and flexible. 

SKIN/SCARS

My skin feels super tight like as if the skin is stretching or has been stretched do to the metal plate. Is that something you experienced and if so did it adjust to feeling okay?

My skin and scars definitely went through different periods of tight-feeling, especially when I started weight-bearing. Your skin might be feeling stretched because…it's being stretched! Around the plate. Which is ok. If it's really concerning you, I'd ask your doc. But for me, I eventually adjusted to the weird and new sensations.

What did your scars look like as they were healing? It feels like my healing is going so slowly.

You asked for it!

Insight from my surgeon: When it comes to scar healing, there’s major variation between people. He says “keloid formation is largely genetic, so ask parents, uncles/aunts, etc. to show you their scars.”

HARDWARE & HARDWARE REMOVAL

What was the deciding factor for you to get hardware removed?

There wasn’t just one deciding factor. My ankle felt super cold in the cold weather, there was a screw sticking out of my ankle bone (under the skin) that gave me the heeby jeebies, it felt uncomfortable in there, and my doc said it was up to me.

Did you get full range of motion after you got the hardware out?

Not right away. But over time with massage, yoga, walking, etc. I’ve gotten pretty darn close.

How long was your hardware in?

9 months

Do you ever regret getting your hardware out?

Um, hell no.

Did you have any problems with the hardware in your leg getting cold when you iced? Every other time I ice my leg I wind up in agony, it's like my bones are frozen from the inside out. It helps so much with the swelling, but the pain is too much.

I did have that! I found that giving your ankle a nice massage/vigorous rub-down (with coconut oil or shea butter) after the icing helps to warm it up and keep muscles loose.

I feel like my hardware really needs to come out, but my doc doesn’t think it’s necessary. What do I do?

There’s no way I can possibly tell you what to do, but I’m all for second and third opinions! The surgeon I ended up with (who I loved) was my second opinion guy. That said, thinking it’s necessary and wanting it out are two different things, and they can both co-exist. It may not be medically necessary, but for your own comfort, it may feel that way. Trust yourself! But also consider expert opinions.

Did you have any swelling after removal?

Yes I did, ice and elevate!

Is there a new scar for hardware removal or do they cut into the original scar?

For me they cut right into the original one. And it actually healed way prettier the second time around.

I can see the screw head on my ankle bone, what do I do?

It's totally normal — it's just really annoying and feels weird. It gets less annoying as time goes on, but mine was removed during my removal surgery which was awesome.

I'm debating about getting my plates and screws removed from my ankle. I'm just really worried about how long the recovery time will take and I can’t take another few months away from work.

My totally non-professional opinion is DO IT. The recovery time is nothing like the first surgery, which is not to say it’s nothing at all, because I don’t want to under-sell it. It’s still surgery and it still sucks. But worst case you can do it on a Friday, and be back at work on Monday (though you may be slightly uncomfortable). More desirable: give yourself a week off. I highly highly recommend it!!

How long until you were able to drive after the removal?

It was about a week before I started driving — but that's because I gave myself that time. I probably could have done it after like five days comfortably. Or four if I pushed it. It was really just my scar that felt super tight, but I wasn't really sore or swollen at that point.

After the removal, did you sleep in the boot or wear it during the day?
I didn't wear the boot at all after the second surgery. I used crutches the day of the surgery, and one crutch the next day for extra support.

Is it true that you walk out the same day? How soon were you able to resume normal activity after the removal? And how severe was the swelling once you started walking on it normally? I can’t go back to recovery the first time around!

Let me take this piece by piece:

• Yes, it was true for me, and seems common, to be walking out on the first day. But I used my crutches and the boot anyway. I started experimenting with putting weight on it the following day and the most notable discomfort was how tight and stretched my skin/incision felt.

• I'd say within 2 weeks I was walking around pretty normally, but there was still a little swelling — which ice/elevation helped with. Within a month, things were close to normalish — resembling how they were before the removal. Normal is, of course, relative.

• The swelling wasn’t severe once i started walking normally. It was more just annoying.

• Closing thoughts on this: I know it sucks to have "elective" surgery — especially since recovery from the first one was so difficult and actually traumatizing. Surgery to remove the hardware is NOTHING like the surgery to get it put in. But I do think some folks minimized the experience, and as a result, I was personally surprised by needing recovery time — and that made me emotional and a little distraught. With this surgery, everything looks way less scary around the surgical site, and you’re mobile pretty much right away, so it seems like recovery should be immediate, but for me it wasn’t and I felt emotional about that. Still, everything was waaaay easier than the first time.  

PERSONAL QUESTIONS

What kind of injury did you have and how much hardware?

My elementary understanding is that I broke the end of my tibia on the inside and the back, as well as my fibula, which is called a trimalleolar fracture. I got 2 plates and 9 screws with an ORIF surgery.

How did you break your ankle?

I was literally stepping out of a car, and my foot got caught between the car and the curb. I lost my balance and SNAP.  

Did you go to physical therapy, and if so, how often and for how long? My medical bills are piling up from this injury; I’m hoping I can rehabilitate myself and skip the PT.

I did — I went to PT for a couple of months, and then continued with 1:1 pilates rehab. It was incredibly helpful, I can’t imagine having tried it on my own. But yes, the bills really do add up. I guess you could either pay for it now to heal the right way, or pay for it later after you heal the wrong way?

How old were you when you broke your ankle?

29.

Did you ever get any hip pain?

I did have hip pain. I'd say my pain was less a symptom of something wrong with my hip, and more because when you're hopping around and favoring one leg over the other, your whole body gets weird. I definitely recommend massage or a good chiropractor who can re-align things. 

How did you deal with all the emotions?

UGH, I had soooo many emotions. So many tears. Honestly, I felt a lot of time feeling sorry for myself, spent a lot of time trying to counteract that and be “fake positive”, cried a lot, distracted myself with Netflix. What helped the most was probably just creating the content and sharing my experience with all of you fellow ankle-breakers and creating community. <3