Beautifully put Catra.

I agree that he WILL make progress. I also agree that it will be slow. There will be good days and bad days but eventually the good days will outweigh the bad ones. It would be great to have care closer but the most important thing is that the care is a good fit.

When I look back at where I was 3 months post-op after my last foot surgery there are a lot of similarities. My dorsal foot was much more discolored. I could only be up for limited periods and the car just killed me. I even thought about trading my car in for a more cushy one because the vibration was horrible and really made me flare. But I kept it and can now drive it without issue. I thought at the time that I didn't have much swelling but looking back I see that even the small amount I had was causing a lot of discomfort. It wasn't even that apparent but it was there and it really ticked off those anterior nerves. And I didn't even have an incision there....

Your son has had multiple traumas to the area and I think it takes a lot longer than they say to get better from this. They had to cut through skin and possibly previously cut ligament to get that hardware out. The little nerves running through there can have sensory changes for 1-2 years post-op as they sprout extra axons, reconnect and have extra axons die off. They can be really sensitive during this time. I would hold on to the long view here. My PM just told me about a study of 10,000 people followed for 10 years after trauma. They had the most improvement in the first TWO YEARS. I know it stinks to think that far out but I there is hope in those numbers. I wouldn't worry too much about his future yet. Worry about making him comfortable now and consistently making the small gains that will accumulate in time to recovery.

On rehabbing - my first 6 months were really hard and I was dumbly doing some things that set me off. I didn't realize this until I quit doing everything for 2 weeks and started up again. It allowed me to identify aggravating factors. It is okay to pull back and adjust the plan every now and then. Walking in the pool is great and I feel land is just a matter of time.

Remember the little things. He responded before to changes like extra cushioning and those little things are important. I still wear a large bandaid over my scar when I exercise. I have no cushion of fat there and the padding makes me more comfortable. I recently bought a new pair of shoes, unlike any I've tried before and they are WAY more comfortable. I THOUGHT I had great shoes already but no. Simple changes like a more flexible or padded shoe tongue can make a difference. Where I lace my shoe makes a difference. I would've thought it didn't matter so much as I'm 18 months out but these things still help. I reduced my pain quite a bit just changing shoes two weeks ago. I went and tried on about 12 different pair and settled on the Nike Free Connect. It's kind of minimal which is the opposite of what I thought I needed. Whodda thunk it?

If you want to explore ketamine I'm afraid it may take travel to do so. Pediatric pain management is hard to come by. It is already a challenge for adults to get it. I know they give it pediatrically at Mayo. U Of M might consider it or maybe Ford?

I'd ask about topical maybe. Something different from lidocaine patches. I used one with gabapentin, ketoprofen and ketamine in it. They can also add clonidine which would open up the circulation a bit. You might also try DMSO still at this point. These things might reduce inflammation. I also recommend PeaPure (palmitoylethanolamide) It is a fatty acid supplement used in Europe for neuropathic pain. I've taken it off and on from the beginning. I have to order from the Netherlands at RS4 Supplements but it arrives super fast.

Has he had a round of steroids? I can't remember. I took 10mg 3x a day for two rounds of ten days at about three months out and it helped a lot.

Get a follow up x-ray if he hasn't had one...

Sorry for all the random thoughts! I know he is going to make improvements. It DOES feel like forever but he really is not that far out. Keep doing what you're doing and hold onto those small gains. They do add up over time.

Sending loads of hugs and healing love,