brand new TPF

[TPF-PT]

I have successfully gone against my OS's wishes and progressed my WB status.  In order to really be considered 50%, you need to be using 2 crutches.  I dumped the crutches and am using a cane along with a DonJoy ACL brace (occasionally).  I have ZERO knee pain but my foot is very painful especially during the first few steps after rise.  My foot pain is isolated to the mid-foot area.  This is because I have limited dorsiflexion (lifting my foot) at the ankle due to a very tight calf.  The motion has to come from somewhere so the joints of the mid-foot region are too mobile.  In order to counter this, I really have to concentrate on maintaining full knee extension at heel-strike and I have started strengthening my intrinsic foot muscles.  I am scheduled to return to work on April 13.  I am going to work 1/2 days to start and I am limiting my patient load to shoulders (much easier to work on with a weak leg).  I have finally concluded that my ROM stinks and will continue to stink as long as the swelling persists so I am not going to sweat it too badly.  I can walk up stairs (stepover pattern) but down remains difficult due to the ROM requirements.

I hope everyone is getting better.

Bo

[maryc]

Way to go Bo.  As you are finding out, going down steps and slopes seems to be the last hurdle.  Keep up the good work.
Sending healing rays your way

[Aggie]

I'm having trouble going down stairs too.  I've got the ROM, so my injured leg will bend at the knee to allow me to step down. The problem I have is still strength.  The knee wants to collapse instead of bending in a controlled manner.  I'm still taking the stairs in the usual way (instead of planting both feet on each) but I use the handrails to take some of my weight.  Then I focus on not letting my foot kick out when I pick it up, and not letting the knee collapse while I'm stepping onto the opposite foot.

Takes time, no?

[StuDogg]

When I first started doing stairs, I found that I had a hard time placing my injured foot accurately, especially going down.  Sometimes, I'd catch my heel on the preceding stair, other times, I'd land my foot halfway off of the step.  Now, I'm doing stairs very comfortably and without much problem, less than two weeks after I started tackling them again. 

[TPF-PT]

I am scheduled to return to work Monday 4/13.  I have been working out out my clinic 3-4 hours a day for the past 2 weeks.  I am still using my cane about 50% of the time, especially in the morning (my left knee feels like concrete in the AM).  I have started walking on the treadmill without my hands on the rails at 2.5 mph for 12 minutes after riding the stationary bike for 20 minutes.  My balance has dramatically improved.  I can stand on the injured leg without support and hold 30 seconds (5 times) and have started doing this on a Dynadisk (unstable surface).  My foot pain persists but I have taught one of the other therapists how to tape my foot to decrease the pain.  Overall, things are SLOWLY improving but I still get impatient and my colleagues have to remind me to slow down.  I will post sometime next week to give the "return to work report". 

Good Luck to all

Bo

[StuDogg]

In PT, I've been using an elliptical trainer, now at four minutes forward and four minutes backward.  I feel like it has helped tremendously.  I go straight from it to the stationary bike for 12 minutes.  On the elliptical, not only does it get my heart pumping, but I feel like I'm able to really work on extending my knee without the impact of walking/running.  When I get off of the elliptical, I'm able to walk with only the slightest limp.

[TPF-PT]

I have not tried the elliptical yet, but I will next week after work (I can finally say that).  Today, I took my twin boys (9yo) to baseball practice.   In the past, I was always their coach but this season, I thought I was going to have to "ride the pine" so to speak.  On the way, I decided not to even take my cane to the field.  I made it to the field without any difficulty so I decided that I would grab my glove and shag some foul balls.  Well, one thing turned to another and I ended up playing 3rd base in a kids vs. parents scrimmage!  I did not have much range and absolutely did not run, but it was great getting out on the field with all of the kids and helping out.  I know that if my OS could have seen me, he would have absolutely killed me (not to mention never again send me any pt referrals).  That was 2:00, now it is 10:00 and I am TIRED but I feel good.  Still working on my crappy ROM but everyday is an improvement.

Bo

[ZRMAN]

TPF-PT, I've been catching up on reading your posts. Good reading.

Ellipticals are good, so are bikes and swimming.
Playing 3rd base---I'm not so sure.?.?.?
Anyway, just try to pace yourself. You don't want to have a set back. That would be very discouraging.

Twenty six months since my tpf injury. Plate and seven screws in and then 9 months later removed.
I can do just about everything I want to do. Running is still ugly. I'm 52 so I don't really need to run anyway. Biking is my thing. At least 1000 miles every summer. Every day I can tell my knee was injured but really not any pain to speak of. More stiffness when tired or lots of use than anything.
Your 40 and should recover even better. You will get there. Sounds like your doing pretty good.

Good Luck.
ZRMAN

[TPF-PT]

Week one is done!  Of course, I worked 1/2 days!  No serious issues, just the swelling and fatigue I would expect after being off for so long.  I did have slight pain yesterday morning along the medial aspect of the knee, but this was minimal and only lasted about 3-4 minutes (my first patient arrived so I was distracted and could not think about it).  Most of my patients are upper extremity right now but I do have 2 ACL patients.  I like to walk next to them and compare our gait patterns.  While writing one of their daily notes, I was a little jealous...his ROM was 0-135!    I did not tell him that I had WISHED I had injured my ACL instead of the TPF...I didn't think that would be appropriate.  

As far as returning to work goes...I think it was the best thing for me at this point both physically and mentally.  I know my limitations and I know what to monitor for.  Believe me, if it doesn't feel right...I'm not doing it!  By the way, I posted my experiences on a similar website and the readers crucified me for returning to work!   I think I will stay put here since everyone is supportive and encouraging!  I have another follow up with my OS on the 29th so I will definitely update at that point.

Best of luck to all!

Bo
 

[sueski]

Hi Bo,
Congratulations on making it back to work. You're fortunate to work with people who understand your situation and can provide support if necessary. I'm sure it also feels good to be out and about while interacting with live human beings instead of the TV etc. I would think you would have a lot more compassion for your patients since you've experienced the whole joyful experience of surgery and rehab.

I just realized that you had your TPF just about the same time I did. Mine was Jan. 23. I also did it while having a wonderful time skiing. I just saw my OS in Vermont on Wednesday and he finally gave me the OK for FWB as tolerated. Today I walked on two legs without crutches for the first time at my PT session. It was amazing! I had no trouble except for some pain on my second lap. How exciting it is to walk on two legs and not to have a limp until the second lap. My PT said not to overdue anything  in all the excitement so as not to have a set back. I'm sure you know what I'm talking about since you've already done the "first time on two legs" thing.

Thanks for sharing your experiences thus far. I think there must be a lot of skiiers out there who have gotten TPFs while enjoying their sport. Are you planning on skiing next year? I know I am. I'm going to purchase a season pass for next year.

Keep us posted.

Susan

[TPF-PT]

Susan,
Congratulations on your "first steps".  Kinda' scary but exciting!  Your PT gave you good advice...don't get in any foot races yet.  As far as skiing goes, I have a few things I have to consider.  First, I live in Texas so I don't get a lot of snow time.  In fact, it is rare that I get to make 2 trips per year.  The closest resort is Angel Fire, NM and it is 11 hours away but it is worth the drive.  We will usually take a long weekend and take the kids.  Speaking of kids, I have 9 yo twin boys who absolutely love skiing so I will definitely be going back.  I will have to hit more greens than blacks, but that is OK.  I told my therapist/coworker that I would not consider myself 100% recovered until I ski the run that did me in. 

I am concerned at this point since my ROM is still very limited (0-100).  I have very little pain/discomfort, but my mobility is affected by the lack of flexion.  When I maximally flex my knee, the "end feel" is hard.  This refers to how it feels when you get to the end.  Does it feel like you hit a brick wall (mine) or does it have a little give to it.  A hard end feel usually means arthrofibrosis.  I have a follow up with my OS on the 29th and we are going to discuss treatment options (MUA, scope, HW removal. etc).

Good Luck

Bo

[coolhunter]

Bo,
Can you please tell exactly the types of RoM's you achieve? My background: tomorrow (the 19 of April) it will be exactly 1 month from surgery following a ski accident I had on the 12th of March (I was run over... ), which gave me a type I Schatzker TPF I had fixed with 4 canulated srews (no plates, No soft tissues damages). I'm 41yo, M, fit. I did have aggressive PT from 31st of March (4hrs daily 6/7 - NOT all on RoM!).
My RoM's are: Active: 100° Self Assisted Active: 118° Passive (CPM) 115° (fullest allowed by the machine).
I'm intrigued by ur "limited" flexion (and obviously sorry that you can't achieve more at present). It looks likeyou started CPM fairly soon following surgery, like I did. Did you get to full end with it? I do have to mention tho that ROM achieved with CPM maybe misleading in some regards due to an amount of cheating you can put through like liftng your hip or foot from the rest  When I was hitting the 115° my PT noticed my (unaware) cheating and once he corrected me then I had to get back to 80° (that was what I could really do!). I'm happy about my overall improvments but i'm really really scared that I may end with limited flexion. When I get to the "end feel" this is painful of course BUT my physiatrist keeps saying that my knee is not locked as he actually can feel he could push more - he doesn't because he knows I would scream mad  So, in conclusion, I've been wondering what didn't work along your PT line! I know that any TPF responds differently etc, but my concerns are of course all there: that I may end with limited flexon too. Thanks for reporting to us your experience, I wish you fullest recovery.
CH

[TPF-PT]

I really think my ROM limitations may be stemming from an old injury.  3 years ago, I ruptured one of the quadriceps muscles in my left leg.  It really tightened up after that.  Combine that with being immobilized for so long has led to my limitations.  Just to remind of my time line...fx on Jan 27...surgery delayed until Feb 12 due to severe swelling...6 week NWB (90% of time locked in extension)...1.5 weeks PWB...0.5 weeks WBAT...return to work without assistive device.  My CPM was started at 30 degrees and increased 5 degrees per day.  I never got to greater than 110 on the CPM because I noticed I was cheating.  My flexion is SLOWLY improving but I know that I will not be able to ski again if it does not get significantly better and I do not want to delay if there are options. 

When I maximally flex (100 degrees), I feel some tension in my quad but I feel immense pressure in the knee itself and it feels locked. 

Bo

[TPF-PT]

Really tired at work today plus, I had a first but not in a good way.  I had some pain (2/10) in and around the patellar tendon which is below the kneecap.  I was trying to function without any brace and I suppose I am not quite ready.  After my last patient, I began my workout and was being assisted by one of my colleagues for my ROM.  I MAYBE got > 100 degrees with max effort  .  After stretches, I was performing some strengthening, balance, and endurance activities and thought, "Hey...my knee feels pretty darn good, almost normal".  Then I remembered that I had just taken 1/2 painkiller!  Oh well. 

[maryc]

I had to laugh at that last part - I did that myself.  Take it slow and steady.