post foot fracture

Ask a PT

156 Posts
 
Posted - 02/18/2008 :  20:48:48  Show Profile  Reply with Quote
Our user asked: "I am a 55 year old woman in very good health. On Nov.4th, 2007 I fell through the attic drywall and landed on my foot. I broke the heel into four pieces and had an additional six fractures in the same foot. I was NWB for 12 weeks, in a cast for about the first six weeks. The ortho doc said I could start on it about two and a half weeks ago. Problem is, I can walk great with one crutch but limp badly with pain without it. My achilles feels like a suction cup when I step and then take the weight off it. I think there is also a mechanical problem in that when I step onto the "bad" foot, my knee has to be locked. I also cannot stand on the foot alone (or without some support). I have been doing ROM since the minute I could. I do achilles stretches against the wall. I tried doing a yoga stretch, the downward dog, but too difficult right now. I have been searching the internet for any info. and thought I might have a soleus problem as I can't do achilles stretch at the wall with my knees bent. I need to get back to work. I am on my feet all day, but work is willing to accommodate me. I know I will not be 100%, but will not accept the way I "walk" now. I have worked my quads, my hip, I stand against the wall with my back against it and do squats, everything I can think of to improve. Sorry this is so long but I wanted to give you a complete picture. Oh, when the weather warms up I can use my pool for therapy as well. Why won't my achilles stay stretched, what can I do to improve my gait(my knee is now starting to pop), and why must I walk with my leg abducted and a straight leg? I have no pain in my heel at all, but do have some pain at the lat. ankle (I think the cuboid was one of the other fractures). Thank you for any help or advice you can offer!"

Ask a PT Response: "Your description of your functional status after sustaining a fracture and undergoing a period of non weight bearing is to be expected. It is common for a patient to limp and experience pain initially when weight bearing and not utilizing an assistive device such as a crutch when ambulating. This is called an antalgic gait pattern which is a pattern utilized by your body to avoid putting additional stresses onto an injured area. You have been in a cast for 6 weeks and NWB for 12 weeks. Your tissue throughout your entire lower extremity has been affected. In the involved lower extremity, you most likely would have experienced a lost of bone density, muscle atrophy, a decrease in muscle strength, tightening of mucles/tendons and ligaments, hypomobility at various joints, edema at the ankle/foot and the development of scar tissue. It will be quite awhile before your body and the various tissues involved returns to its prior state.

I am surprise you are not participating in physical therapy. It sounds like you are doing some of the things a PT would have their patient doing for such an injury. However, it may be a good ideal to work with a PT if you are able to. This will give you better direction in regards to the path for your recovery. As far as being able to walk normal again- meaning no crutch, not having your knee locked throughout gait, pain etc... It will take alot of work. It is common for a PT to break up the task of walking into "parts" as far as exercises go and then putting the various parts together to create the whole of normalized gait. For the initial functional exercises which helps the patient's body get use to bearing weight again, the PT could have the patient hold onto a railing or countertop (support) and have the patient work on partial lunges with support, sidestepping with support, 1/4 wall slides, step up/down on 2inch step with support, or bilateral (both feet at the same time) heel raises/toe raises with support. In addition, the PT would work on having the patient strengthen his her ankle/foot/knee etc.. where needed and have the patient work on improving the ROM, flexibility and joint mobility at these regions as well. The pool is also an excellent medium for patients' to perform exercises in as the buoyancy of the water takes some added stress off of the involved lower extremity.

It is too early in the game to determine if you have a problem with your muscle such as your soleus. You could be experiencing weakness and tightness there but you need to address all your other possible issues which are mentioned above as well. Pain at your lateral aspect of your ankle could be a result of your fracture but could also be a result of poor mechanics with ambulating which would place additional stress to this region. For now, it would strongly be recommended that you continue utilizing an assistive device such as your crutch or a standard cane when ambulating so that your lower extremity can continue to get use to bearing weight and for you to not develop further abnormal gait mechanics. It is also important to utilize an AD because your body will compensate to allow you mobility which could result in abnormal streses and injury to other areas of your body as well ie. other lower extremity, back etc.. . If you see a PT, he or she will be able to help you achieve a more normal gait pattern and wean you off your assistive device. I hope this helps. I wish you the best as you work towards your recovery."

Ask a PT

156 Posts
 
Posted - 02/18/2008 :  20:50:15  Show Profile  Reply with Quote
Our user replied: "I can't thank you enough for responding to me and for your wonderful advice! I go to the VA for my care, and although I've received great care, the thinking is once the bone is healed, everything is ok. Not quite. As soon as I received your email, I was all over those exercises! I can side-step fine, so I did a grapevine instead and that is a little tricky, so I know I'm on the right track. I had totally forgotten about lunges and those are a good challenge also. I am so excited and am encouraged now, and it is because you were there to "listen" to my complaints and offer me something other than "just walk on it and it will get better". I know there's more to it than that. I know that your web site and the care that you provide will help many, many people, who, like me, know that there is more that can be done after an injury. I am lucky enough to have a little knowledge of PT and I really feel for those who don't and have to "suffer" longer than necessary in order to achieve a better rehabilitation. Thank you again, so very much! Not only for your excellent assessment, but for the psychological boost as well."